Program Exclusion Verification Databases and FACIS Searches for Health Care Providers

Health care providers and contracting entities (“Providers”) have an affirmative duty to check the status of individuals and entities they hire or contract with to ensure they have not been excluded from participation in Medicare, Medicaid, or other Federal health care-related programs because of prior engagement in fraud or abuse.  Providers should perform these verifications prior to entering into, and periodically throughout the duration of, employment or other contractual relationships.[1]  If a health care provider or contracting entity fails to check an individual or entity’s Federal health care program exclusion status, it runs the risk of incurring Civil Money Penalty (“CMP”) liability.[2]  To avoid such liability, Providers should, at a minimum, review the System for Award Management (“SAM”) and the Office of Inspector General (“OIG”) List of Excluded Individuals/Entities (“LEIE”).[3]  In addition, Fraud and Abuse Control Information Systems (“FACIS”) searches provide a means of obtaining information regarding adverse actions taken against individuals and entities in the healthcare field.  Some sources for verifying whether individuals or entities have been excluded from participation in Medicare, Medicaid, or other Federal health care-related programs or whether adverse actions have been taken against individuals and entities in the healthcare field are summarized below.

SAM
The System for Award Management (“SAM”) is the official database operated by the United States Government that contains information regarding debarment actions taken by OIG[4] and various other Federal agencies, whereas the LEIE (discussed below) lists only exclusion actions taken by OIG.[5]  Providers may access SAM by clicking here and registering for a free user account.  SAM recently replaced the General Services Administration’s (the “GSA’s”) Excluded Parties List System (“EPLS”).  The GSA continues to administer SAM.  

LEIE
The OIG List of Excluded Individuals/Entities (“LEIE”) contains information regarding individuals and entities that are excluded by OIG from participation in Medicare, Medicaid, and all Federal health care programs. The LEIE lists only those parties that have been excluded from participation by OIG.  No other exclusion authority is reflected on the LEIE. This is different from the content of SAM, which reflects OIG exclusions and debarment actions taken by Federal government agencies.  The LEIE is located at http://exclusions.oig.hhs.gov.

Although SAM provides a more comprehensive listing of debarment actions and includes actions also reported in the LEIE, a provider should check both SAM and LEIE, as the LEIE is the primary source of information regarding OIG exclusions, it is maintained by OIG, and it provides more details about persons excluded by OIG than SAM does.[6]

FACIS
FACIS is a database containing information regarding adverse actions taken against individuals and entities in the healthcare field.  There are three (3) levels of FACIS Reports, each providing a different degree of information.  Several healthcare background check providers provide all three (3) levels of FACIS checks.  

A Level 1 FACIS searches for enforcement actions taken by OIG, GSA, and other federal agencies. It complies with the federal government’s minimum requirements in OIG’s Compliance Program Guidance for Nursing Homes[7], Hospitals[8], and Individual and Small Group Physician Practices[9], as it checks both SAM and the LEIE.

A Level 2 FACIS search includes the federal agencies search in Level 1 FACIS, and adds a search of state agencies for one State of choice.

A Level 3 FACIS check is the most comprehensive level.  It encompasses a Level 1 FACIS search and adds adverse action information from state agencies and licensing and certification agencies in all 50 states.  It exceeds the minimum federal requirements and offers maximum coverage for risk compliance. 

For further questions on program exclusion verifications or SAM, OIG and/or FACIS searches, please contact Carrie Flores at cflores@kdlegal.com or Meghan Linvill McNab at mmcnab@kdlegal.com.


[1] Office of Inspector General, Special Advisory Bulletin: The Effect of Exclusion from Participation in Federal Health Care Programs (Sept. 1999).
[2] Id.
[3] Office of Inspector General Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs at 15 (May 8, 2013).
[5] Office of Inspector General Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs at 17 (May 8, 2013).
[6] Id.
[7] 73 Fed. Reg. 56832, 56840 (Sept. 30, 2008) Available at https://oig.hhs.gov/compliance/compliance-guidance/docs/complianceguidance/nhg_fr.pdf.
[8] 70 Fed. Reg. 4858, 4876 (Jan. 31, 2005), Available at https://oig.hhs.gov/fraud/docs/complianceguidance/012705HospSupplementalGuidance.pdf.
[9] 65 Fed. Reg. 59434, 59442 (Oct. 5, 2000), Available at https://oig.hhs.gov/authorities/docs/physician.pdf.