Reduce manual administration of sanction checks to ensure payment processing and avoid penalties
Healthcare organizations are prohibited from conducting business with excluded or sanctioned individuals or entities. The Office of Inspector General (OIG) has the authority to enforce exclusions against individuals or entities across all states under the Affordable Care Act. An individual or entity excluded in one state is not permitted to participate in federal healthcare funds in all other states. The effect of an OIG exclusion is payment prohibition due to involvement of excluded individuals and entities. This payment prohibition applies to all methods of federal healthcare program payments: itemized claims, cost reports, fee schedules, capitated payments, etc.
In order to identify sanctioned entities, a healthcare organization must manually search through a litany of federal and state databases. Unfortunately, most of these sanction checks are only done periodically and inconsistently due to the significant resource requirement.
Software to reduce resource commitment and ensure payment processing
SanctionShield was developed to provide an automated, comprehensive, and continuous exclusion and sanction checks across 41 Federal and State databases.
- Automation of exclusion and sanction checks of your vendors and employees against all available exclusion lists
- Continuous checking of existing and new employees and vendors
- Proactive compliance: self-disclosure and notification to the OIG of any compliance violations
- Maintenance of a comprehensive compliance audit trail
- Avoidance of thousands of dollars in OIG monetary penalties for prohibited exclusions conduct