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A LICENSED PROFESSIONAL’S COMPLETE PROFILE IS A MOSAIC OF DATA FROM VARIOUS SOURCES

January 31, 2019

Licensed health care professionals are a mosaic of data. A professional career can take a provider across state lines, and through an evolution of various license types. In order to see the full picture of an individual, the comprehensive whole of each state licensing board across all license types must be searched.

A common assumption is that you’re covered with a search of the Federal Government’s databases of exclusions: The Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE), and the System of Award Management’s (SAM) Excluded Parties Lists System (EPLS), or the National Provider Data Bank (NPDB).

If these are the only data sets that your organization is screening against , it is still exposed to risk.

The mechanics of licensure data sharing are not commonly understood. While states issue and monitor practitioner licenses, it is up to each state’s licensing board to report licensure status and actions to the OIG and the NPDB. This either doesn’t happen in a timely manner, or doesn’t happen at all. Take the process back another step. If an action is not already known to the respective state licensing board, it is up to the medical professional to report any adverse actions that affect the status of that individual’s license. As a result, in many cases, disciplinary, criminal or abuse actions are not self-reported.

Additionally, many states have their own Medicaid exclusionary databases and/or state procurement debarment sources. It is not uncommon for a provider to end up on one of these lists, but never show up in the OIG or SAM exclusionary databases   

So, from this perspective, there are excluded individuals who never make the centralized Federal lists, or do so after the legal process which can take many months. What if you could have near real-time access to press releases about arrests and charges? Minutes from state licensing board meetings on sanctions, suspensions and disciplinary actions? Access to all of the state Medicaid exclusionary and state procurement debarment sources?

Verisys, provides this critical information as verified data retrieved exclusively from primary sources in real time, and delivers in a variety of ways; from a dashboard as an instant search result, or through an enterprise-wide secure platform with dynamic views to each provider’s full career profile.

Close the Gap by Aggregating Jurisdictional and Federal Data Sets

Verified License Search and Status® (VLSS) by Verisys is a real-time data platform that actively gathers, verifies, and aggregates primary source data on health care providers from licensing boards in all U.S. states for all license types.

Add Verisys’ proprietary data set, FACIS® that actively scrapes data from more than 5,000 primary source publishers. FACIS® stands for Fraud Abuse Control Information System and began its data acquisition/aggregation process in 1992. The longitudinal view that provides historical perspective as an overlay to real-time data is invaluable when inviting a licensed health care provider to join your team and treat your patients.

If the pieces of the puzzle are not fitting together completely and accurately, a provider or physician that “should be” excluded could continue to practice medicine on your patients indefinitely.

In a USA Today / MedPage article by John Fauber and Matt Wynn, published November 30, 2018, the authors found that more than 250 doctors surrender licenses in one state and continue to practice in a different state. One example in particular exposes Larry Mitchell Isaacs, MD as having surrendered his license to avoid discipline in Louisiana, California and New York before settling in Ohio where he continues to practice. He leaves behind a path of tragic mistakes that irreparably altered the course of patient lives. In Louisiana, he removed a healthy kidney instead of a portion of the colon. He surrendered his license to avoid discipline and began practicing in California where he removed a fallopian tube instead of the appendix, which was already removed. Then in a subsequent surgery on the same person, he left the woman’s intestine unconnected. In New York, he was facing actions against his license because of his prior mistakes, so he surrendered his license there, and looked to Ohio where his license appears unblemished while working at an urgent care clinic.

Had the initial state of practice communicated about the voluntary surrender, would the other states have issued licenses? With VLSS® and FACIS®, a health care institution or a state licensing board has real-time access to historical as well as current information about the status of 6 million licensed health care practitioners.

Patients rely solely on your credentialing and privileging process to be assured they and their families are receiving the highest quality of care. Using the tools available to ensure you are keeping your promise to your patient community is core to the oath.

GAP 2 of “Achieving Transparency Through Closing 5 Critical Gaps in Credentialing”, is brought to you by Verisys Corporation, creator of the most powerful health care data platform delivered by cutting-edge technology providing full transparency that protects your reputation and your patients.

The e-book, “Closing the 5 Critical Gaps: A Guide to Understanding the Issues and Using Data Technology to Improve Provider Transparency to Protect Patients and Reduce Risk” is available to download here.

As an NCQA Certified and URAC Accredited Credentials Verification Organization, Verisys manages all data reports as a Consumer Reporting Agency abiding by federal law set forth in the Fair Credit Reporting Act. Verisys stores and exchanges data from a Tier 3+ secure environment, assures 99.9+% identity resolution accuracy 99.9+% of the time and assures its promises with full indemnification.

Verisys earned and sustains compliance with two international quality standards, ISO 9001:2015, certified for quality of credentialing software and background screening; and, ISO 27001, certified for highest standards of information security and data protection.

The sum of these certifications and accreditations ensures that promises made are promises kept to the world’s highest standards.

Contact us for a demo of FACIS®, and discuss a staged rollout of screening, verifying and monitoring your entire workforce.
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