Once excluded, never reinstated?

Posted by Frank Strafford on December 9, 2014 in Exclusion Reinstatement, Industry News,

OIG exclusion verification

In a previous post, we made the wry observation that even death can’t get an excluded individual off of the LEIE – unless the deceased undertakes (no pun intended) official reinstatement protocols.  As it happens, we’re learning that even reinstatement is no guarantee of reinstatement.

Here’s what happened.

Steve, one of our employees, was running a routine exclusion verification check for a client.  One particular employee – let’s call him Dr. Girard Michael Jeffers of Queens, NY – was flagged by our software.  The exclusion turned up in an entirely different state (for clarity’s sake, let’s pretend it was Alabama,) and the reason for the exclusion was listed as, “Excluded by another state.”  That was strange, because New York, Dr. Jeffers’ state of residence, did not list him as excluded… and neither did any other state aside from Alabama.

Steve figured that the most likely explanation was that Dr. Jeffers had been excluded in Alabama as a result of a prior exclusion in New York; but after being reinstated in New York, was never reinstated in Alabama.  Losing no time, Steve got in touch with one of Streamline Verify’s contacts at the New York State Office of the Medicaid Inspector General (OMIG).  Sure enough, our contact confirmed that Dr. Jeffers had been reinstated into NY Medicaid in November of 2013, (more than a full year prior!) after being found ‘not guilty’ at trial.

Steve’s last step was to bring all of this information to the attention of the appropriate officials in ‘Alabama’ – who sheepishly agreed that Dr. Jeffers should have been removed from the Alabama List of Suspended Providers long ago, and promised to remedy the error forthwith.

And so Dr. Jeffers was saved from a lot of unnecessary heartache; our client was saved from unjustly taking action against an innocent employee; and everybody lives happily ever after.

Until the next time this kind of thing happens.

Obviously, State systems are not perfect.  Exclusion databases cannot be assumed to be 100% accurate, and it takes an experienced employee – like Steve – to properly weed out the innocent from the guilty.  We firmly believe that our software, Verify Professional, is the best exclusion screening software available on the market today.  Still, software is just software; computers can’t make distinctions like people can; and when a name is flagged, the computer has no way of intelligently figuring out whether or not the exclusion is legit.

Happily, there’s always Verify Enterprise, Streamline’s full-scale service which is operated by intelligent and experienced exclusion verification screening experts.  Like Steve, they’re committed to pursuing each and every flagged match all the way down to its final conclusion…

Especially when it comes to protecting the innocent.

Check out this great resource for all questions on OIG Exclusion of the State of New York and the New York OIG Exclusion List.

 

About Frank Strafford

About Frank Strafford

Related Articles

Florida OIG Exclusion

July 5, 2016

Florida Healthcare Exclusion Under the State of Florida’s Agency for Health Care Administration (AHCA) is the Office of the Inspector General, spearheaded by Chief Kelly Bennett. As an integral par...

Fraud in the time of the ...

May 10, 2021

Along with significant scientific and medical challenges, COVID-19 has also revealed significant fraud-related challenges. Some are novel and some are variations on age old schemes. This article addre...

Apache Log4j Vulnerability – What You ...

December 21, 2021

Background On December 9, 2021, security researchers discovered a flaw (also referred to as a vulnerability) in the code of a software library used for logging security and performance information....

Understanding OIG Exclusions

OIG Exclusions Screening Process

Exclusion FAQS

Quick OIG Exclusion Basics

Employing Excluded Individuals

Consequences to Employing an Excluded Individual

OIG Compliance Law

Laws and Publications on OIG Compliance

More Compliance Resources

About Us

Industry leader Streamline Verify has been forging new paths in Exclusion Screening.

Trusted for Good Reason

  • ✓ Guaranteed accurate
  • ✓ Certified Secure
  • ✓ Audit Proof
  • ✓ Feature-rich reporting
  • ✓ Round the clock real-time-data
  • ✓ Processing fully automated

Security First

  • ✓ Cloud hosted
  • ✓ Encrypted data
  • ✓ Real-time backups

Trusted for Accuracy

  • ✓ Physical security
  • ✓ Restricted access
  • ✓ Single sign-on
  • ✓ Password security
  • ✓ Certified secure
  • ✓ Cross checking

HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY

5

60%

Average workload reduction by implementing the Streamline Verify program

5

10K

Establishments trust Streamline Verify nationwide

5

2011

Serving the healthcare industry’s unique compliance needs since 2011

5

24X

Setting standards with hourly synchronization to primary source data

[class^="wpforms-"]
[class^="wpforms-"]