MMHA 6220 Week 4 Sanction Screening Policy Example

Sanction and Background Screening Policy for Bellwood Valley Home Health: A Screening Matrix by Population and Source, Consent Under the FCRA and a Match Procedure With One Owner

Student Name

Walden University

MMHA 6220: Human Resource Management in Healthcare

Instructor Name

Month Day, Year

Sanction and Background Screening Policy for Bellwood Valley Home Health: A Screening Matrix by Population and Source, Consent Under the FCRA and a Match Procedure With One Owner

1. Purpose

This policy ensures that Bellwood Valley Home Health does not employ, contract with or appoint anyone excluded from federal health care programs, and that people who enter patients' homes are appropriately licensed and screened. An agency that employs or contracts with an excluded individual may face civil monetary penalties and repayment of amounts paid for that person's services. The Office of Inspector General advises providers to check its exclusion list before hiring and periodically afterward, and notes that many providers check monthly (Office of Inspector General [OIG], 2013). The agency is fictional, and it is placed in a composite state whose Medicaid agency publishes its own exclusion list.

2. Scope

This policy applies to all employees, contracted clinicians, volunteers and members of the board of directors.

3. Screening Matrix

Two rules explain the matrix. First, monthly checks apply to every population that could cause the agency to bill for an excluded person's work or to be governed by one, which is why board members are included. Second, the agency screens contracted clinicians itself even when a staffing firm attests that it has done so. A firm's attestation is useful evidence, but the agency bears the penalty if an excluded clinician treats its patients, and a monthly search takes minutes.

License verification is done with the issuing board's online lookup, not from a copy of the license, because copies can be altered or out of date. The verification printout, dated, goes in the personnel file.

Table 1

Screening Requirements by Population and Source

Contracted clinicians supplied by a staffing firm are screened by the agency even if the firm attests to its own screening.

4. Consent Before Background Reports

Criminal background reports obtained from a consumer reporting agency are subject to the Fair Credit Reporting Act. Before ordering a report, HR gives the candidate a clear disclosure, in a document consisting only of that disclosure, that a report may be obtained for employment purposes, and obtains the candidate's written authorization (15 U.S.C. § 1681b). Exclusion list checks are searches of public databases and do not require consent, but candidates are told in the application that they will be performed.

5. Pre-Adverse Action Notice

If HR is considering not hiring or ending the employment of a person based in whole or in part on a background report, it first sends a pre-adverse action notice enclosing the report itself and the federal summary of consumer rights before making a final decision (15 U.S.C. § 1681b). The person is given five business days to dispute the accuracy of the report or provide context. HR considers the response, along with the nature of the offense, the time elapsed and its relation to the job, before deciding. If the decision is final, HR sends an adverse action notice with the information the statute requires.

6. Match Procedure

When a monthly check shows a possible match, the following steps apply.

Verify: the compliance officer compares identifying information, such as date of birth and license number, and confirms the match through the listing agency's verification process. Name matches alone are not treated as matches.

Remove from assignments: if the match is confirmed, or cannot be ruled out within one business day, the individual is removed from patient assignments and any billable work pending review. The scheduler reassigns patients.

Escalate: the compliance officer informs the administrator and, where required, the agency's counsel. If the person was excluded while working for the agency, the compliance officer calculates claims involving that person's services since the exclusion date and the agency follows the OIG's self-disclosure guidance.

Close: the outcome is recorded, and the individual is notified in writing.

7. Recordkeeping

For every monthly run, the compliance officer saves dated evidence: a screenshot or export of the search results for each list, showing the date and the names searched, and a summary of any matches and their outcome. Records are kept for at least ten years, consistent with the agency's records retention schedule for compliance documents.

8. Responsible Owner

The compliance officer owns this policy and the monthly screening process. The HR manager is responsible for the hiring-stage checks and consent forms and sends a monthly roster of all employees, contracted clinicians, volunteers and board members to the compliance officer by the fifth business day. A single owner ensures that no population is missed because each office assumed the other was responsible.

9. Reporting and Training

The compliance officer reports to the board's compliance committee each quarter: the number of people screened, any possible matches and their outcomes, and any month in which a run was late. HR staff, schedulers and the compliance officer's backup receive annual training on the matrix, the consent steps and the match procedure, so that screening continues when the owner is absent.

10. Legal Basis

The Secretary of Health and Human Services may bar people and organizations from federal health care programs for listed offenses and conduct (42 U.S.C. § 1320a-7). Federal programs will not pay for anything an excluded person furnishes, orders or prescribes, and that bar extends to administrative and management services paid for indirectly by those programs (OIG, 2013). This policy exists to make sure Bellwood Valley never submits such a claim.

References

Exclusion of certain individuals and entities from participation in Medicare and State health care programs, 42 U.S.C. § 1320a-7 (2018).

Fair Credit Reporting Act, 15 U.S.C. § 1681b (2018).

Office of Inspector General. (2013). Updated special advisory bulletin on the effect of exclusion from participation in federal health care programs. U.S. Department of Health and Human Services.