Following the launch of its Primary Source Verification API, Propelus today announced the launch of its healthcare Exclusions Monitoring API. The Exclusions Monitoring API is part of the company’s data solution offerings and is designed to ensure healthcare providers, payers, vendors, and contractors take appropriate compliance measures to safeguard against fraud, waste, and abuse.
The Department of Justice (DOJ) estimates up to $100 billion annually is lost to healthcare fraud, waste and abuse. Individuals and entities who have been involved in fraudulent activities are added to federal and state exclusion lists, which prevent payment from being made to the excluded party, as well as any hospital or other healthcare provider where the excluded party provided services or was otherwise engaged.
Additionally, hospitals and healthcare organizations face severe legal consequences, costly civil monetary penalties (CMPs) and fines, and reputational damage when engaging with individuals or entities excluded from federal healthcare programs or government contracts due to previous misconduct resulting in an exclusion.
“Healthcare organizations and payers serve an important role in mitigating fraud, waste, and abuse and are responsible for not engaging or paying for any services from any individual or entity that is excluded. Our OIG compliant Exclusions Monitoring API provides monthly monitoring of healthcare exclusions and ensures exclusions intelligence is accessible how, when, and where it is needed for more informed, real-time compliance with ease.”
– Julie Walker, CEO of Propelus.
Complementary to the Propelus Primary Source Verification (PSV) API with daily monitoring of over 8,300 licenses, certifications, registrations, sanctions, and more source types, the Propelus Exclusions Monitoring API empowers on-demand, bulk submissions with identity resolution, indexing and reconciling identifiers, and match capabilities to ensure any excluded individual or entity is detected. It delivers the most up-to-date exclusions data through monthly checks against primary sources, while ensuring proper connectivity within the broader compliance management ecosystem for better workforce compliance operations.
The Exclusions Monitoring API monitors the following federal and state exclusion lists:
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- HHS-OIG LEIE: Health and Human Services (HHS), Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE)
- GSA SAM: General Services Administration (GSA) System for Award Management (SAM) – the SAM.gov database is formerly known as the GSA list of Excluded Parties Lists System (EPLS).
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- All currently available (45) State Medicaid Exclusions Lists: Many states maintain their own exclusion lists to identify individuals or entities barred from participating in Medicaid programs due to fraud or other violations.
For more information about the Propelus Exclusions Monitoring API and how it can support your organization’s workforce compliance efforts, visit propelus.com/api.