Background checks are a standard part of the pre-hire process, but who's looking out for an employer after the contract's signed?
All too often, employers find themselves paying hefty state or federal fines months or even years following a new hire. Medicare fraud, licensure issues, patient abuse and criminal histories often take months to come to light, costing employers an average of $105,000 in fines for a single employee.
That realization was the fuel behind ProviderTrust, a Nashville-based healthcare compliance technology company whose solutions help companies across the nation stay compliant with the OIG exclusion list. ProviderTrust was one of the first in the compliance space to offer an in-house, full-service, employee monitoring package.
Fulfilling a Need
"We're a combination business that does both compliance monitoring and making more efficient software to track and notify employers about license status," said Michael Rosen, who started ProviderTrust with business partner Chris Redhage in 2010. "These seemed to be the least funded and least attractive parts of healthcare, and no one was paying attention to them."
According to the company's Compliance Healthcare Index Report, which was released in June, federal fines for employing or contracting with an excluded person or entity nearly doubled from $4.47 million in 2015 to $8.13 million in 2016.
A former attorney, Rosen left his legal practice in 1995 to launch his first entrepreneurial venture, Background America. "I really wanted to do something where I could go to sleep knowing I was helping to make the world safer," Rosen said.
Although the company was sold to a New York-based intelligence firm in 2009, Rosen still heard complaints from clients who had no way to track employees after a hire. Employer liability began on the hire date, but licensing boards only reported changes monthly.
During this period, Rosen was introduced to Redhage, an expert in the medical staffing and technology fields. The duo soon launched ProviderTrust and immediately received funds to develop software and begin testing.
"The test hospitals thought it was awesome because they knew when nurse licenses were coming due, and we alerted staff on their behalf," Rosen said. "We took a lot of inefficiencies and labor off their hands because we were monitoring all state license boards and the OIG exclusion list on an ongoing basis."
A Lot to Manage
While data used by ProviderTrust is publicly available and free, managing a large employee database is nearly impossible for employers with multiple locations in multiple states. That's because there's more than 42 state and federal lists of people or companies that have been excluded.
"Even if a company has a way to hit 42 of those, how would a company with 200,000 employees know which John Smith or Maria Garcia was theirs?" questioned Rosen, who noted many traditional services simply provide an aggregate list of similar names to be weeded through by the employer.
"What we do each evening is update those public lists to capture and scrub it to run against all names and provide results through a secure, easy-to-use webpage each morning."
ProviderTrust currently monitors over 2 million people for more than 350 companies, including six of the nation's 10 largest nursing home chains. Another piece in the growing compliance puzzle is the Nurse Compact Act, a new piece of legislation being implemented in various states. The Act allows providers to cross certain state lines as a traveling healthcare professional without obtaining a license in each state. "Our technology was built to follow a provider wherever he goes," Rosen said of meeting that challenge.
Looking Back & Forward
While today's healthcare employers understand the need to ensure employees and vendors stay off lists that would prohibit reimbursement from Medicare or Medicaid, Rosen said that wasn't the case in pre-ACA 2010. "Back then it was discussed as a good idea and if it passed would be dealt with," he explained. "Our company bet on the right trajectory of what would be on the minds of compliance officers in healthcare companies."
Rosen said post-hire monitoring is imperative for today's healthcare employers. "If it's been two years and someone's progressed through your company, he's not going to tell you: 'Oregon just excluded me,' or that his license got suspended somewhere else," he said. "The 95 percent of people in healthcare follow the law and aren't stealing drugs, but the five percent that cause problems will cost you huge fines, because they won't volunteer that information," Rosen pointed out.
Once questionable activity is suspected, the reporting and discipline process can be notoriously slow, giving an employee ample time to find a new job elsewhere. Rosen said employees typically have four to six months before being disciplined through the state. And since disciplinary boards often meet quarterly with results published one month later, employees have plenty of time to secure a new job in another state and pass a background check while still under investigation. That's bad news for the new employer, since every billable item related to that employee, right down to surgical tray preparation, can be rejected and result in fines of up to $10,000 per patient per day.
"There's a lot of opportunity to commit fraud, waste and abuse in healthcare, and some people just want to get lost in the system," Rosen said. "We provide a really important service that makes those penalties 100 percent avoidable for employers."