FACIS the Comprehensive Data Source of Medicare and Medicaid Exclusions

FACIS^® (Fraud Abuse Control Information System) is a comprehensive database that collects data from Federal sources, as well as each jurisdiction, for all healthcare provider taxonomies. One login provides access to thousands of aggregated primary sources with real-time results on State and Federal exclusions, sanctions, debarments, and disciplinary actions.

Medicare and Medicaid exclusion and sanction information originates from hundreds of individual sources. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) publishes the List of Excluded Individuals and Entities (LEIE) that tracks exclusion from Federal entitlement programs. State Medicare programs, in conjunction with respective state licensing and medical boards, determine Medicaid exclusions and license restriction and revocation.

Checking licensed practitioners for exclusion is just the beginning of remaining in compliance with government entitlement programs. It is critical that healthcare institutions not hire or contract with an excluded individual or entity, or if engaged, that an excluded individual or entity does not provide services that are funded by the Federal Government, or a State healthcare program.

Civil Monetary Penalties and fines will be applied to those seeking Federal or State reimbursement from any of the following that are excluded: practitioners, manufacturers, distributors, suppliers, drug plan sponsors, managed care entities, or any person or entity that directly or indirectly furnishes, refers, pays, or arranges for healthcare items or services.

Prior to 2010, when the Patient Protection and Affordable Care Act (ACA) was signed into law, a provider was allowed to participate in a Medicaid program in any other state other than the state where the provider was excluded. But with the new law in place, an exclusion in one state means exclusion in every state and every government-funded program.

Today, many healthcare institutions still only screen for exclusions in the state where the provider currently lives and provides services. This leaves room for providers who are excluded in one state to participate illegally in government programs in other states.

The OIG published a report in 2014 that followed a study and recommended actions that could improve the way the Centers for Medicare and Medicaid (CMS) makes available exclusion information state-to-state. The study found that 12% of providers excluded in 2011 in one state were still participating in Medicaid programs in other states in 2012, and some ongoing into 2014. Various Medicaid programs paid $7.4 million to 94 providers after these providers had been excluded in a state other than where they were practicing and submitting for reimbursement. The final recommendation stated in the report included this observation: “…we found the lack of a comprehensive data source of providers terminated for cause creates a challenge for State Medicaid agencies.”

Verisys Corporation began its mission in 1992 of creating a single repository of data where healthcare organizations could check for exclusions, sanctions, debarments, and disciplinary actions in order to achieve and remain in compliance for receiving reimbursement. Today, the database contains more than 8 million records that are aggregated and verified, with most records identity matched to entities and individuals. FACIS is a unique database for healthcare because of its historic, accumulated data going back to the mid 1980’s. All of this data is aggregated and verified against current, real-time data, making it the most comprehensive and accurate healthcare data set in the country.

Verisys’ FACIS is the comprehensive data source for real-time transparency on individuals and entities delivering healthcare services or supplies. Whether a provider is participating in a government-funded program or not, it is in the best interest of healthcare organizations to know if a provider has been excluded anywhere for reasons of fraud, misconduct, or harm to patients. Searching the FACIS portal, or receiving FACIS results via API, provides an accurate view of a provider or entity you can trust.
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