If a doctor has a sanction, they have a disciplinary case in their record. A sanction is a disciplinary action.
This article discusses why healthcare sanctions exist, how they happen and why they happen. You will also find out how to screen your doctor for sanctions. If you need a deeper sanction check, run a professional healthcare sanction screening.
What Exactly Is A Healthcare Sanction?
A medical or healthcare sanction is also called an exclusion. It is an exclusion from government insurance programs. It’s a means for the government to ensure public trust in the healthcare system. The government bans a healthcare provider or professional from receiving payment from a federal program like Medicare.
Why Do Doctors Get Sanctioned?
Doctors get excluded from government insurance because they committed some violations. Many times, a sanction follows a license suspension or revocation.
Some common reasons for healthcare sanctions include:
- Medicare Fraud. Fraudulent doctors conduct unnecessary tests, scans, and medications to bill Medicare. It’s unethical and harms the patients.
- Other healthcare financial fraud.
- Deliberately harming a patient. This includes medical malpractice, negligence, and abuse.
- After a felony conviction like illegally distributing controlled substances
Doctors get sanctions to prevent further violations. Sanctions protect Medicare beneficiaries from dangerous doctors. But despite the Centers for Medicare and Medicaid Services (CMS) best efforts, some doctors keep practicing and receiving federal payment after sanctions. It’s illegal.
What Does It Mean When A Doctor Gets Sanctioned?
Sanctions mean that the doctor made an offense, and the government does not recognize their authority. A sanctioned doctor should not receive federal payment through programs like Medicare for their services.
A sanctioned doctor should also not make prescriptions through federal programs. If a sanctioned doctor benefits from Medicare directly or indirectly, they risk penalties like fines and jail terms.
Who Places Healthcare Sanctions?
A State Medical Board imposes sanctions on healthcare providers after a thorough investigation. The doctor gets a hearing to clear their name before a sanction is finalized. And even after the sanction, the doctor can appeal the decision in a federal court.
A sanction tells you that the doctor did not provide a satisfactory reason to dismiss a sanction. After the State Medical Board imposes a sanction, the Department of Health and Human Services (HHS) Office of Inspector General implements the sanctions.
The OIG executes sanctions and maintains a list of sanctioned medical providers. It is called the List of Excluded Individuals and Entities. The OIG updates the LEIE monthly. This database is readily available to employers when screening candidates and employees. When you begin a sanction screening, start with the LEIE.
The OIG is one of the offices that can exclude a healthcare provider from the federal healthcare program. A state Medicaid program also excludes providers from federal funding. The Food and Drugs Act can also impose a sanction after an FDA violation.
Should You Work With A Sanctioned Doctor?
A sanction is an easy indicator that the doctor could be dangerous to patients or the hospital. It’s best to avoid sanctioned doctors. It’s also illegal to hire sanctioned doctors or do business with sanctioned healthcare organizations.
If the OIG finds that you deliberately hired a sanctioned doctor, your organization will pay a fine in the best-case scenario. The leaders could serve time, and the hospital can get a sanction. The OIG recommends periodic checks on sanction lists.
How To Learn More About A Doctor’s Sanction
If your doctor has a sanction and you want the details (type, period, cause), here are some sanction lists to look at.
- The OIG’s List of Excluded Individuals and Entities (LEIE). The OIG has made it easy for employers to determine if their employees have sanctions through freely accessible LEIE. You can view this list through the OIG’s portal.
- The Fraud and Abuse Control Information Systems (FACIS). The FACIS database has exclusions from other offices besides the OIG.
- Look through your State’s Medical Board.
- The OFAC sanction List Search.
- Professional healthcare sanction screening. If you still can’t find what you’re looking for, then a professional background screening company will help. They have the resources to run intensive background checks according to your needs.
A sanction screening gives you peace knowing that you hired the right talent. With reliable and trustworthy healthcare professionals, your organization gains the public trust you need.