What is a Mandatory Exclusion in the Healthcare Industry?
Protecting patients and employees within the healthcare industry is critical for leaders and healthcare HR professionals. The Office of Inspector General (OIG) must, by law, ensure that individuals and entities who have committed fraud, waste, or abuse can no longer participate in federal healthcare programs, like Medicare or Medicaid. In this blog, we explore what a mandatory exclusion is and the impact it can have on a healthcare organization or individual. We’ll also share some key ways you can work to avoid issues with mandatory exclusion through regular audits and compliance checks. Definition of Mandatory Exclusion Mandatory exclusion is a legal requirement to exclude participation in federal healthcare programs following an individual or entity’s conviction for various criminal offenses. Common reasons for being included on the list include Medicaid or Medicare fraud; fraud related to the State Children’s Health Insurance Program (CHIP), Tricare, or other state programs; patient abuse or neglect; felony convictions for fraud, theft, or other financial misconduct; and felony convictions involving the unlawful manufacture, distribution, prescription, or dispensing of controlled substances. Those organizations or individuals who find themselves on this list cannot receive payment from federal healthcare programs. Keep in mind that you’ll also find permissive exclusions on the list. These exclusions may result from misdemeanor convictions related to healthcare fraud, fraud in a program other than a healthcare program, misdemeanor convictions for the unlawful manufacture, distribution, prescription, or dispensing of controlled substances, or the suspension, revocation, or surrender of a healthcare license due to issues of competence. The term of exclusion usually sits in the one to three-year range for these types of exclusions, compared to five years to indefinite exclusion with mandatory exclusions. Common Contexts for Mandatory Exclusions Mandatory exclusions impact the individual or organization on the list and can put your organization at risk. This impact is why organizations must check the list monthly to avoid finding themselves in legal trouble or at risk for non-reimbursement due to having someone on the exclusions list perform services on behalf of their organization. Exclusions apply to all employees, whether licensed or not, as well as contractors, vendors, and referring physicians. Many state Medicaid bulletins suggest monthly monitoring of ordering and referring physicians, underscoring the importance of regular checks to ensure compliance. Consequences of Mandatory Exclusion You’ll find immediate and long-term consequences if your organization or an individual working within your organization finds themselves on the list. Mandatory exclusion usually results in a minimum of five years on the list, but this can be indefinite depending on the severity of the crime or issue that got you on the list. Professional licenses, certifications, and employment will likely be revoked, leaving you with little choice but to find another type of employment. Your reputation within the healthcare industry will be damaged because of this exclusion, and you’ll find that financial penalties can be imposed on you during the exclusion process. In order to get yourself off the list can be a very long and costly process, with many individuals and organizations finding it impossible to remove themselves from the list following their addition. For employers, the impacts are equally significant. Federal health care programs will not make payments for any items or services furnished, ordered, or prescribed by an excluded individual or entity. The payment prohibition extends to the excluded individual or entity, anyone employing or contracting with the excluded party, and any hospital or other provider for which the excluded party performs services. While there is a limited exception for certain emergency items or services not provided in a hospital emergency room, the broader implications of exclusion pose significant operational and financial risks for employers. Avoiding Mandatory Exclusions To avoid mandatory exclusion, ensure that you always follow the best practices set by the industry and the regulations surrounding state healthcare programs. Compliance checks and regular audits can help you avoid getting on the list yourself and stop you from engaging with anyone on the mandatory exclusion list. Should you find out that someone you employ or work with is on the list, it’s critical that you immediately take action to stop your involvement with them. The list is updated each month, usually in the second week of the month. It’s important that your team gets into the habit of regularly auditing the list and your employees so that you can take action should someone appear on the list. When hiring a company or working with a new employee, review the list before offering them employment or setting up business contracts. These steps protect your organization and its reputation and will help you avoid ending up on the list yourself for fraud or other illegal activities. Conclusion | About Propelus Understanding and avoiding mandatory exclusions is critical for anyone operating a business within the healthcare industry. Propelus can support your efforts. We recently announced the launch of our Exclusions Monitoring API, which 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. Additionally, our EverCheck by Propelus solution delivers the most up-to-date primary source data, including exclusions monitoring, so you can have confidence that your workforce is compliant and in good standing. By remaining in compliance, you’ll work to protect your reputation, avoid potential loss of trust, and ensure you also don’t end up on the list in the future.
Shining a Light on HR Excellence: Celebrating Human Resource Professional Day
At Propelus, we understand that people are the heartbeat of any organization. That is why we celebrate Human Resource Professional Day, honoring the essential role HR professionals play in nurturing and sustaining vibrant workplaces. This day is an opportunity to reflect on the value of HR teams and their impact on driving career growth and professional development. Join us as we explore how to honor HR professionals and why their work is vital to organizational success. What is Human Resource Professional Day? Human Resource Professional Day, observed annually on Sept. 26, recognizes the indispensable contributions of HR professionals. This day not only celebrates their achievements but also highlights the often-overlooked scope of their work. It’s a chance to deepen your understanding of HR’s role and to express appreciation for their unwavering commitment. Why Honor HR Professionals in Healthcare? In the dynamic field of healthcare, celebrating HR professionals is crucial. Here’s why we at Propelus believe it’s important to recognize their efforts: Talent Acquisition and Retention HR professionals in healthcare are key to attracting and retaining exceptional talent. Their dedication ensures that healthcare facilities are equipped with skilled, compassionate professionals who provide outstanding patient care. While they may not interact directly with patients, their work is foundational to the effective operation of your organization. Employee Well-being HR teams are champions of employee well-being, driving initiatives that promote wellness, mental health, and work-life balance. In the high-pressure environment of healthcare, their efforts are vital for maintaining morale and preventing burnout. By supporting these initiatives, you contribute to a more balanced and engaged workforce. Training and Development Continuous learning and development are central to healthcare excellence. HR professionals facilitate programs that keep staff up-to-date with the latest healthcare practices and technologies. This ongoing education not only boosts employee confidence but also enhances the quality of patient care. Compliance and Ethics Navigating complex regulatory requirements and ethical standards is a critical function of HR teams. By managing these aspects, HR professionals allow other leaders to focus on delivering exceptional patient care. Compliance and ethics requirements within your business protect the organization and its employees from legal issues and help maintain a culture of integrity. Crisis Management During challenging times, such as the COVID-19 pandemic, HR professionals have been instrumental in managing workforce dynamics and implementing safety protocols. Their support during crises is a testament to their resilience and commitment. If your team members have a personal challenge, they can always turn to your HR team for extra support and advice. Cultural and Organizational Leadership HR professionals shape the culture of healthcare organizations, fostering an environment of inclusion, collaboration, and respect. Their role in building a supportive and empathetic workplace is crucial for organizational success. By celebrating HR colleagues on Human Resource Professional Day, you acknowledge their role in maintaining a high standard of care and employee support. Ideas to Honor Healthcare HR Professionals Inspired to celebrate Human Resource Professional Day? Here are some thoughtful ways to recognize and appreciate your HR team: Thank You Notes from Staff: Encourage colleagues to write personal notes or create thank you cards for HR colleagues, showcasing their appreciation for the team’s dedication. Lunch or Dinner with Leadership: Organize a special meal around Sept. 26, offering senior leaders the chance to express their gratitude and celebrate HR professionals. Gift Packages: Delight your HR team with personalized gift packages that reflect their interests, demonstrating your appreciation for their hard work. Customized HR Appreciation Video: Create a video featuring testimonials from employees and leaders, highlighting the positive impact of your HR team. Display the video prominently to raise awareness of their contributions. Final Thoughts Human Resource Professional Day is the perfect opportunity to recognize and celebrate your HR team’s hard work to ensure a safer, healthier, and more compliant workforce. Propelus is dedicated to helping HR professionals equip their workforce with the resources they need to perform at the highest level. Through our industry-leading solutions—EverCheck, Immuware, and CE Broker—we’re powering professionals with the tools they need to achieve professional compliance and ultimately, provide safer healthcare with better outcomes. This Human Resource Professional Day, we thank the HR professionals in healthcare who help their organizations provide the best care possible.
Celebrating One Year as Propelus: A Look Back at Our Progress
Written by Julie Walker, CEO at Propelus One year ago, on August 1, we excitingly announced our new brand, Propelus. This is a defining moment in our company’s history, and it more formally brought our brands – EverCheck, CE Broker, and Immuware – together as one unified company, all with a focused vision, mission, common set of values, and clear, customer-centric strategy. We knew we were on to something really special! A nod to our history We are honored and humbled by our unique history of over 20 years. Our founder’s vision was to help the Florida Department of Health (FL DoH) ensure their continuing education requirements for their licensed professionals were satisfied, which was foundational to our future. The FL DoH partnership was further instrumental in helping us develop and grow over the years to become the most trusted full-lifecycle continuing education management solution for government agencies, licensure departments, boards, and compacts. We embraced the opportunity to continuously evolve, innovate, and deliver meaningful solutions, introducing EverCheck. First, we assisted healthcare organizations in Florida, and soon after that, we expanded to a national footprint with the first-of-its-kind primary source verification and monitoring solution essential for dynamic workforce compliance management and to ensure professionals are Clear to Work®. In early 2023, we welcomed Immuware, a modern, intuitive, and professional-centric solution for Employee Health and safety (EHS) screening and surveillance. Ensuring the entire workforce – employees, vendors, contractors, students, and more–are healthy and safe to work – another critical element of workforce compliance in the broader human capital management ecosystem. Realizing our potential Our customer-centric, values-driven, and innovation-focused approach is core to our organization. Our many trusted professionals and their employers, licensure boards, agencies, and more helped us realize that our organization, as one company, has far-reaching potential with the focus on making a meaningful impact across our broader healthcare ecosystem. So, we stacked hands and set forth on our journey… We came together as one Propelus Team We embarked on this journey much earlier, in 2023. We started with our values. We believe they are our DNA. They are a blueprint that guides every interaction and decision and informs how we behave, operate, engage, and grow. We gathered thousands of inputs from our organization, customers, and other industry experts. We reviewed, discussed, and debated. We stacked hands, and here we are today. We have refreshed values, an even clearer vision, mission, and strategy–focused on powering professionals–connected through modern technology and united by our new brand, Propelus. We have laid an even stronger foundation for modernizing how professionals, employers, regulators, educators, and partners work together. Further, our “propeller” logo accentuates the full spectrum of what we do and the future we envision. Powering our progress We are excited to share a snapshot of our Propelus highlights: We serve more than 5 million professionals across our Propelus solutions. We partner with 400+ healthcare systems and several hundred licensure boards. We verify and monitor 8.3k primary data sources & professions for total workforce compliance. We process millions of license verifications, certifications, and registrations daily. We track more than 30 types of immunizations, screenings/surveillances, and injuries/illnesses. We’ve been honored with three Silver Stevie Awards, the world’s premier business awards, and Best Place to Work awards. We have delivered many exciting innovations for our customers, and even more are coming soon! Sharing our gratitude We are beyond grateful for our customers. They are central to why we exist, what motivates us to do meaningful work, and are vital to our future. Further, I am beyond proud of our Propelus team. We have had an exceptional first year as Propelus, and it is a true testament to our commitment to being a healthy, high-performing organization. One that embodies our values, the hustle & heart, passion & compassion, and determination makes Propelus an exceptional organization with an even brighter future – one that I am grateful and honored to lead. We are grateful for the progress we’ve made, and at the heart of everything we do is ensuring we meaningfully help safeguard our nation’s communities and workforce for safer, more compliant, healthier, and happier professionals. Cheers to Powering Professionals!