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Breaking down the basics of healthcare screening and best practices for OIG compliance

Lorinda Walters (lwalters@appriss.com) is Director, Healthcare Screening Solutions, at Appriss Insights in Louisville, KY.

No industry has remained immune to the challenges of this year’s labor shortage, but the demand for workers in the healthcare sector is more complicated than most. Healthcare organizations and employers are responsible for the safety of millions of patients, so at the same time as they deal with a dire need for new employees, they must ensure that the individuals they employ are properly licensed, have a clean history with their licensing board, and are not excluded from any state or federal programs.

According to data from the occupational employment statistics from the Bureau of Labor Statistics, in 2019 there were more than 20 million people working in healthcare and social assistance.[1] By 2029, the Bureau of Labor Statistics projects more than 23 million people to be working in healthcare, making it one of the largest and fastest-growing industry sectors in the United States.

The magnitude and complexity of the industry makes screening for issues challenging, and the process for screening providers in various healthcare-related, publicly accessible databases is not a smooth or easy one. The inter-relationships among government agencies that maintain their own exclusions lists can be opaque even to veterans of the industry.

The key to finding and retaining healthcare providers and maintaining quality standards is to understand the differences between three main industry compliance requirements—sanction, exclusion, and termination—as well as the best practices for screening out questionable providers.

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