The Office of Inspector General (OIG) maintains a list of individuals and entities excluded from federal healthcare programs due to violations such as fraud, patient abuse, or criminal convictions related to healthcare. It is essential to check the OIG exclusion list to ensure a provider is not barred from participating in these programs. Hiring or contracting with someone on the list could lead to legal and financial issues, including civil penalties, improper billing, or poor patient care.
To run an OIG report on a provider or staff member:
- Click Providers or Staff on the left side of any RFX screen.
- In any tab (Active, Pending, or Inactive), click the View button
next to the person’s name. - In the provider’s or staff member’s file, click the Actions button at the top right.
- Select Add New Document.
Must Know! This step must be set up as a workflow in the Provider or Staff Library before it can be run for the.
- In the Document Type field, type “OIG” and select it from the dropdown menu.
- Click Run OIG Report or manually upload a previous report.
- A dialog box will prompt for the provider's Date of Birth. Enter the information and click Save and Run Verification.
- A side-by-side view will appear showing the results on the left and ways to identify the document on the right. The report can be archived at this stage, especially if uploading older reports.
- Click Save.
The profile will display relevant information, including the date the report was run and any issues found.
Monthly Monitoring
Monthly monitoring can be enabled in the Provider or Staff Library settings (see Setting up the Provider Library or Setting up the Staff Library).
When enabled, RFX will automatically verify all OIG reports in the facility and send an email with the results. This process runs on the 1st of every month.
For a provider to be monitored monthly, the following conditions must be met:
- The provider or staff must be active.
- The provider or staff must have an active OIG Report document on their profile.
Monitoring emails will be sent to all system administrators unless the settings are overridden in the "Notifications" section under Settings (Sanctions – Monthly Email). Monthly monitoring will be displayed as either green or red on the dashboards and the profile.