Criminal Background Checks

Hand holding a magnifying glass

Like any industry, our industry of credentialing continues to evolve and progress.  Many medical staff professionals can recall old methods and techniques used to verify credentials in an effort to prove current clinical competency.  The depth of verification and the methods used to gather data continue to evolve, as new resources become available.  Personally, I can remember when verifying education of foreign medical graduates was a tedious process with letters exchanged in different languages that required interpretation.  Today, we rely on the Education Council for Foreign Medical Graduates (ECFMG) for verification of education in foreign countries. 

Recently, it seems the changes in credentialing process have been in response to case law.  Several cases come to mind immediately.  Dr. Christopher Duntsch has become known in our industry as Dr. Death as many of his patients died when best credentialing practices were not followed.  Dr. William Husel was charged with 25 counts of murder related to fentanyl overdoses in Ohio in June 2019.  Cases such as these create doubt about patient safety.  Our job as medical staff professionals is to protect the patient against incompetent or criminally inclined physicians and other non-physician providers.

Due to the notoriety of recent cases involving incompetency and criminal behavior on the part of providers, it is clear that organizations will be evaluating and often times deepening their processes to assure they are comprehensive and effective in order to protect patients, mitigate their financial risks as well as the risk of a damaged reputation. One way/method to do this is through the addition of a criminal background check in our credentialing processes/procedures.  Moreover, as is usually experienced in our industry, there is no consistency or standardization of this additional step. 

In the 2019 Annual Report on Medical Staff Credentialing conducted by Verity, a HealthStream company, 80.6% of the 591 respondents to the annual survey indicated centralization and enterprise/industry standardization were extremely or very important.  90.2% of 317 respondents perform background checks on new applicants to the medical staff. Of these 82.5% were performed by the credentialing department/medical staff office. 

A recent post of the American Health Lawyers Association (AHLA), posed a question of the depth of criminal background checks.  While some facilities have adopted a criminal background check required by and limited to Federal and/or State law (often times in response to a human resources employment verification), other facilities have adopted policies of  5, 7, or 10 year depth of criminal background history upon initial appointment and reappointment of the provider.  I find this to be interesting that the depth of the criminal background check at the time of reappointment often times mimics the same depth as that of initial appointment even though reappointment is typically required every 2 years. 

Standardization and adoption of best practices (depth of criminal background check and what department is responsible for the criminal background checks) will be debated in the coming years.  Obviously, the addition of the criminal background check is not standardized throughout facilities across the country; I believe the addition of the criminal background check will become a common practice in our industry.  Whether this function is performed by human resources or embedded in the traditional credentialing and privileging processes, most criminal background check laws (Federal and State) are aimed at protecting the facility from employees with a criminal history (and were not intended to micromanage hospital’s credentialing/privileging functions as to who is best suited to practice medicine in certain facilities).

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2019 Small Business Awards Finalist

Medical Provider Resources was recently named a finalist for the 15th annual Small Business Awards program through the Wichita Regional Chamber of Commerce. MPR was one of three Tier 2 companies (6 to 20 full time employees), other Tier 2 finalists include Headshots Bar & Grill and National Screening Bureau. Click here to see the other finalists.

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Social Security Death Master File and LEIE Monitoring

Medical Provider Resources recognizes the need to meet federal and state regulations as they pertain to basic credentialing and monitoring functions. The Social Security Death Master File is a computer database file made available by the United States Social Security Administration since 1980. The file contains information about persons who had Social Security numbers and whose deaths were reported to the Social Security administration from 1962 to the present, or persons who died before 1962, but whose Social Security accounts were still active in 1962. MPR is registered with the Limited Access Death Master File (LASMF) as an entity with a genuine fraud prevention interest.

The final rule published in the Federal Register on June 1, 2016 describes how institutions and others may become certified to received data from the LADMF. Per the CMS Medical Program Integrity Toolkit to Address Frequent Findings 42 CFR 455.436, “The Social Security Administration’s Death Master File (SSADMF) must be searched at the time of enrollment to ensure that Medicaid is not being billed in the name of a deceased provider.” Disclosure of search results outside of the MPR service agreement is strictly prohibited under 15 CFR 1110.200. Furthermore, according to the CMS Medical Program Integrity Toolkit to Address Frequent Findings for federal database checks (42 CFR 455.436), “In addition to conducting their own ongoing exclusion searches, states should instruct all enrolled Medicaid providers to check their own employees and contractors for exclusions against the LEIE – List of Excluded Individuals and Entities- at the time of hiring and on a monthly basis.”

In response to the federal regulations, the Social Security Death Master File at the time of initial appointment, in addition, MPR will query the LEIE monthly on behalf of any provider covered under a MPR Centralize Verification Service (CVS) agreement. The findings of the LEIE monthly query will be provided to each participating entity in the On-going Monitoring Service (OMS) report.

Medicaid Program Integrity – Toolkits to Address Frequent Findings: 42 CFR 455.436
State Medicaid Director Letter #09-001, dated Jan. 16, 2009
42 CFR 1003.102 Basic for civil money penalties and assessments
42 CFR 1002.3 Disclosure by providers and State Medicaid agencies
NTIS Final Rule on Limited Access Death Master File

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One Response to Social Security Death Master File and LEIE Monitoring

  1. Ashley says:

    This is a great article. Does anyone know how this is handled at other facilities? Specifically who is responsible for running the monthly queries?

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