april 27, 2009 · loss of employee’s licensure millie johnson, jd, cpc, ccep institutional...
TRANSCRIPT
� Exclusion Authority Statutes (SSA)◦ 42 USC 1320a-7 and 42 USC 1320c-5
� Impact of Exclusion◦ No payment by a federal health care program for items/services provided/ordered/directed/prescribed by an excluded individual/entity
� Includes Management/Administrative Services
� DHHS – OIG◦ Authority to exclude from federal health care programs
◦ Maintains list of excluded individuals and entities(LEIE)
◦ Impose CMPs for violations 42 USC 1320a-7a(a)
� Excluded Parties List Service◦ EO 12549 & 12689; 31 USC 6101 note; 48 CFR 9.404� Government-wide Nonprocurement Suspension and Debarment Common Rule (68 FR 66533)
� List of each Agency’s rules: http://www.epa.gov/isdc/reg.htm
� Federal Agencies & their Contractors Prohibited from Employing/Contracting with those on the LEIE◦ Federal Grants, Cooperative Agreements, Contracts
� What it Does and Does Not Include◦ Entities debarred, suspended, proposed for debarment, excluded or disqualified under the nonprocurement common rule, etc.◦ Accuracy of information NOT guaranteed!
� See 42 CFR 1002 – State – Initiated Exclusion from Medicaid◦ Does Not Require Publication of Exclusion List
� State Exclusion Lists◦ Texas Medicaid Exclusion List
◦ New York List of Providers Not Allowed to Order/Bill
◦ https://www.desc.dla.mil/dcm/files/state%20suspension%20and%20debarment%20websites.doc
� CMS Letter to State Medicaid Agencies
� Office of Foreign Assets Control (OFAC)◦ Administers and Enforces Economic and Trade Sanctions based on US Foreign Policy & National Security
◦ Enforces economic sanctions that prevent trade or financial transactions and other prohibited dealings
� Specially Designated Nationals List (SDN)◦ OFAC publication listing terrorist, drug traffickers, those with ties to certain countries
◦ US citizens and permanent residents are prohibited from doing business (trade and financial transactions) with those on the SDN
� BIS Lists◦ Denied Persons List: Those Denied Export Privileges◦ Unverified Lists: Parties who BIS was unable to verify in a prior transaction - Raises a “red flag” to resolve before conducting any transactions◦ Entity List: Those whose presence in a transaction may require an export license under EAR� Includes those formally listed on General Order No. 3
� State Department ◦ Debarred List : Those barred under ITAR (defense items/info)◦ Nonproliferation Sanctions
� FDA – Debarment List 21 USC 335a◦ Individuals restricted from receiving investigational drugs, bioloigics or devices based on FDA determination.
◦ Cannot work for a drug manufacturer in any capacity
� Disqualified, Restricted and Assurances List for Clinical Investigators
� ORI – PHS – Administrative Actions List
� Part of an Effective Compliance Program (FSG)◦ Due diligence – Knew or should have know standard
◦ Limited – Substantial Authority Individuals
� Fair Credit Reporting Act - Employees◦ Internal v. External Agency
� State Laws
� U.S. Sentencing Guidelines:
“ careful delegation of authority and due caredue caredue caredue care in hiring/screening employees”
� OIG Compliance Program Guidance:
“ employeesemployeesemployeesemployees, contractorscontractorscontractorscontractors and medical and clinical medical and clinical medical and clinical medical and clinical staff staff staff staff checked routinely (e.g. at least annually) against OIG LEIE and GSA EPLS”
� Federal Acquisition Regulation:
“review EPLS prior to prior to prior to prior to contract award”
� Research Applicable Government Lists
� Identify Risk Populations
� Select Routine Check Intervals
� Consider What Other Departments Are Doing
� Decide In-House or Vendor Database Search
� Apply Verification Procedures for Potential Matches
� Initiate Appropriate Action on Verified Matches
� Document Policies & Procedures
� Federal Lists
- OIG / GSA / FDA
- OFAC / DOC / DOS
� Populations:
- All University Employees (Semi-Annual), plus all New Employees at Time of Hire
- Affiliated Research Personnel (Semi-Annual)
- Commercial A/P Vendors $1,000 + (Annual), plus all New Contractors/Subs Prior to Award
- Procurement Card Vendors $1,000 + (Annual)
(Templates #1 & #2)
� All Applicable Lists Included in Database
� Variables Included in System Checks (Full Name, Address, DOB, SSN/TIN)
� Auto Elimination of Non-Matches In Future Search Results
� Data Security and Record Retention
� System Administrator Feature Allows CO to View All Departmental Searches/Results
� Annual vs. Per Search $ Fee
� Name/Date of Birth per VOD Summary Report
� Social Security Number
� Date of Birth per Federal Agency Records
� Address / Action Date Analysis
� Certification Form
Template #3 – Verification Procedures
Template #4 – Potential Match Review Sheet
Template #5 – Employee/Affiliate Certification Form
� Name per VOD Summary Report
� Tax Identification Number / SSN
� Address Review
- City/State Per Federal Agency Record
- Central Contractor Registration Review
� Certification Form
Template #6 – Verification Procedures
Template #7 – Potential Match Review Sheet
Template #8 – Vendor Certification Form
� Finding Federal Agency Lists/Resources
� Understanding List Nuances/Pitfalls
� Deciding if Government Agency Contact is Necessary
� Determining Specific Action Necessary for Verified Matches
� Initial Check◦ Background Checks
� Employees, Students and Residents
◦ Volunteers – GSA EPLS List Check
� Annual Reviews◦ “Batch run” against on-line databases
� Employees (including Residents), Vendors and Contractors
� Matches◦ Referred to Institutional Compliance Office
Template #9 – Process for Contracts/Purchasing
� Vendor Contractual Language
� Temporary Employees
� Volunteers
� Students who are not Employees
� Loss of Employee’s Licensure
Millie Johnson, JD, CPC, CCEP
Institutional Compliance Officer
Texas Tech University Health Sciences Center
806-743-3950
Robin Wilcox, CPA, CHC, CCEP
Associate Compliance Officer
University of Louisville
502-852-1371