In September of 1999 the DHHS Office of Inspector General released a Special Advisory Bulletin concerning "The Effect of Exclusion From Participation in Federal Health Care Programs". This document provided a more detailed explanation of when services rendered by an excluded provider are not reimbursable. Within the Bulletin it was made clear that not only were federal funds not to be used for individuals and entities directly involved with patient care, but that Civil Monetary Penalties (CMPs) could be imposed for using federal funds for excluded providers that were indirectly involved in patient care. In addition, "no federal program payment may be made to cover an excluded individual's salary, expenses or fringe benefits, regardless of whether they provide direct patient care."

It is extremely important for organizations to be aware of excluded providers among hires and contractors due to potential CMPs as well as the possibility of the organization being excluded from participation in federal healthcare programs. However, as has often been reported in the media in the last year, there are other providers who have been the subject of adverse actions not taken by the federal government but by state licensing agencies. This second category of adverse actions could cause an organization to suffer monetary penalties as well, not necessarily from the government, but from civil suits and public relations problems. FACIS^® helps to identify providers reported by both types of agencies, state and federal, therefore substantially decreasing an organization's risk of government sanctions and/or monetary penalties from civil suits.

Depending on the level of involvement with patient care, FACIS^® suggests using a multi-tiered search process for the most cost-effective screening. In order to ensure that an organization dealing with healthcare providers is protected, we suggest screening individuals and entities in the following way.

Level 1 - Low risk employees and contractors or those who are not involved with patient care

Level 2 - Moderate risk employees and contractors such as administrators

Level 3 - High-risk individuals and contractors or those who are directly involved in patient care such as physicians, nurses, physical therapists, etc.