What is Sanctions Screening?

Sanctions Screening Definition

Sanctions Screening is the organization’s primary defense against fraud, waste, and abuse (FWA). For Payer and Health System Executives, this process is a mandatory requirement for participating in federal programs like Medicare and Medicaid. Screening involves checking a provider's identity against multiple lists, including the OIG LEIE and the System for Award Management (SAM). Operationally, the risk is not just at the point of hire, but throughout the provider’s entire tenure. If a provider is sanctioned on a Tuesday and the organization does not catch it until a month later, every dollar paid to that provider during that window may be subject to "clawback" by the federal government. To mitigate this risk, enterprise-grade operations are shifting from periodic (monthly) screening to "Continuous Sanctions Monitoring" to ensure that any change in a provider’s standing is caught and acted upon within 24 to 48 hours.

FAQs

How frequently should a payer perform sanctions screening?

While federal law requires monthly checks for Medicare/Medicaid participation, many organizations now perform daily or real-time screening to minimize the financial risk of paying excluded providers.

What is the risk of "False Positives" in sanctions screening?

False positives occur when a provider has a similar name to a sanctioned individual. This requires a manual "resolution" process using NPIs or Social Security Numbers to verify identity, which can slow down the onboarding workflow.

Does a state-level sanction affect a provider’s national standing?

Yes. Often, a sanction in one state will trigger a "reciprocal action" in other states and may eventually lead to federal exclusion from the OIG LEIE list.