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Are You Conducting Regular Exclusion Checks?

November 17, 2020
Compliance By LW Consulting Inc.

The word “audit”, regardless of the context, is usually enough to give people anxiety. During challenging times like these, dealing with a Centers for Medicare & Medicaid Services (CMS) audit is probably the last thing that a provider wants to address. But, by taking a proactive approach to auditable information, such as Exclusion Checks, organizations can be ready to handle an audit quickly and efficiently.

We know that CMS is currently conducting an audit for calendar years (CY) 2018 and 2019. According to the Office of Inspector General (OIG), the audits are “to identify ineligible providers that had been excluded, precluded or deactivated as Medicare providers but provided services through Part C and D sponsors.” These audits are to help determine if Part C and D sponsors are in compliance with Federal requirements on preventing ineligible providers from rendering services to Medicare beneficiaries.

As a best practice, providers should be verifying individuals and entities prior to engaging with them and, on a monthly basis, to determine if particular individuals or entities are considered excluded providers. If a provider has determined they are working with or using an entity that is an excluded provider, they would immediately stop work and report.

Technology can help you stay on top of this process through the use of an exclusion software that scans your individuals and entities on a monthly basis to determine if your information contains excluded providers. For example, LW Consulting, Inc.’s LWEnSCheck® service can help facilities maintain compliance with these Federal requirements. LWEnSCheck® was designed to help providers satisfy their exclusion check requirement while also providing the means for these providers to save and reallocate their internal resources. Clients can choose to use the software autonomously and independently.

LWEnSCheck® allows for efficient and multiple sanction database checks to independently conduct screenings for excluded and sanctioned individuals and entities. The service includes searches of multiple databases such as the General Service Administration Excluded Parties List System/System for Award Management (SAM), Office of Inspector General’s List of Excluded Individuals and Entities (OIG LEIE), and state exclusion lists.



For more information about how LWEnSCheck® can help you, contact Jennifer Matoushek at 717-213-3130 or email

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