We are a licensed private investigative firm that partners with hospitals, health plans, assisted living & home care agencies, schools, and government agencies to provide monthly OIG/GSA and state-level exclusion checks, including all investigation activities, to identify employees, physicians, and vendors/contractors that cannot receive federal medical assistance money (e.g., Medicaid/Medicare).
There are 21 reasons that a person/company can become excluded, including patient abuse, felony drug charges, and failure to repay healthcare student loans. Paying money to an excluded party will result in mandatory restitution (payback to Medicaid/Medicare) plus severe fines and penalties for your organization. The Centers for Medicare and Medicaid Services (CMS) has advised all state-level Medicaid agencies to require monthly exclusion checks. These checks are public law in certain states. All states will require Providers to pay back any money paid to excluded parties. Since most organizations have one operating account, this means that if you receive any federal medical assistance money, this money is being paid to everyone, including employees, referring physicians, and all your vendors and contractors. This means that everyone needs to be screened for excluded status against both federal and state-level exclusion lists. In our business, we use proprietary software and systems to screen all exclusion lists at once. We have over 300 sources that are updated weekly. In addition to exclusions, we can identify any professional license sanctions and Medicare opt-out status. All exclusion checks are based on name information, either individual or company names. When there is a match, our licensed investigators will work to either confirm or clear the name match. When we confirm an excluded party, we work with you to examine all documentation regarding the exclusion, and provide you with a confidential report. Our clients range from large, established hospitals, to small home health agencies, to schools (who receive ACCESS money for classified students), to government agencies (e.g. county health and human services). We provide personal and confidential service to help companies manage their risks in this area of compliance.
