Purpose

Federal law prohibits payment under any federal health care program for items or services furnished by a person or entity that has been excluded from program participation. Because ABAS is funded by public healthcare programs, including MassHealth, employing or contracting with an excluded person would expose ABAS to repayment demands, civil monetary penalties, and loss of program standing. This policy establishes how ABAS screens its workforce, contractors, and vendors against federal and state exclusion lists before hire or engagement and every month thereafter.

Scope

This policy applies to all ABAS employees, including the BCBA Team, Behavior Technician Team, billing, and administrative employees, to ABAS's owners and any governing board members (if ABAS establishes a board), and to every candidate to whom ABAS extends an offer of employment. It also applies to all contractors who furnish services on ABAS's behalf and to all vendors who supply items or services that ABAS bills, directly or indirectly, to MassHealth or any other federal or state health care program. Screening occurs before hire or engagement and monthly for the duration of employment or the business relationship.

Definitions

Policy Statement

5.1 Screening Requirement

ABAS screens every prospective employee and contractor before hire or engagement, and every vendor before entering a business relationship, against three exclusion lists:

1. The OIG List of Excluded Individuals/Entities (LEIE).
2. The SAM.gov exclusion records.
3. The Medicaid exclusion list of each state in which ABAS operates (in Massachusetts, the MassHealth suspended or excluded provider list).

ABAS re-screens all current employees, active contractors, active vendors, and its owners (and any governing board members, if ABAS establishes a board) against all three lists every calendar month. No offer of employment is finalized, and no contractor or vendor begins work, until screening is complete and clear.

5.2 Prohibition

ABAS will not employ, contract with, or purchase from any excluded individual or entity for any role or function connected to services billed to MassHealth or any other federal or state health care program. This prohibition reflects the exclusion authorities at 42 U.S.C. § 1320a-7: no federal health care program payment may be made for items or services furnished by an excluded person, or at the medical direction or on the prescription of an excluded person. Submitting claims for such items or services exposes ABAS to repayment obligations and civil monetary penalties.

5.3 Duty to Disclose

Every employee and contractor must notify the Compliance Officer within one business day if they are excluded, suspended, or debarred from any federal or state health care program, or if they become aware of a pending action (such as a criminal conviction or license revocation) that could lead to exclusion. Candidates are asked to disclose any exclusion, suspension, or debarment before hire. Failure to disclose is itself a violation of this policy.

5.4 Response to a Confirmed Match

If screening confirms that an employee, contractor, or vendor is excluded, ABAS will immediately remove that person or entity from all work connected to federally or state-funded services. The Compliance Officer will determine whether ABAS billed for any items or services the excluded person furnished, and ABAS will disclose and repay any affected claims as the payer requires. The matter is documented and handled under POL-003 (Compliance Reporting, Investigation, and Resolution).

5.5 Documentation and Retention

ABAS documents every screening: the date, the lists checked, the names screened, the result, and the name of the person who ran the check. Records of pre-hire and pre-engagement checks, monthly re-checks, match verifications, and any resulting actions are retained for at least six years. These records are ABAS's evidence, in an audit or payer review, that screening actually occurred.

Procedures

Responsibilities

Steps

1. Before any offer is finalized or any contractor or vendor begins work, the responsible role (Section 6 Responsibilities) screens the person or entity against the LEIE, SAM.gov exclusions, and the Medicaid exclusion list of each state in which ABAS operates.
2. Each calendar month, the Employee Relations Specialist re-screens all current employees and active contractors, and the Director of Operations re-screens all active vendors, against the same three lists. The monthly re-check also covers ABAS's owners and any governing board members, if ABAS establishes a board.
3. The screener documents each check (date, lists checked, names screened, result, screener) and files the record. Records are retained for at least six years.
4. If a check returns a potential match, the screener does not act on it alone. The screener forwards it to the Compliance Officer, who verifies identity using additional identifiers (such as date of birth and, for the LEIE, Social Security number verification) before treating the match as confirmed.
5. On a confirmed match, the Compliance Officer notifies the Executive Director, and ABAS immediately removes the person or entity from all federally and state-funded work. The Compliance Officer reviews whether any claims included items or services furnished by the excluded person and coordinates disclosure and repayment with the payer.
6. The matter is logged and resolved under POL-003 and its Compliance Ticket Management SOP, and the Compliance Officer reports the outcome to the Compliance Committee.

Training Requirements

All ABAS employees receive training on this policy during onboarding, including the duty to disclose in Section 5.3, and at least annually thereafter as part of compliance refresher training. The Employee Relations Specialist, Director of Operations, and Compliance Officer receive role-specific training on running the three list checks, documenting results, and handling potential matches. The Compliance Officer tracks training completion and reports it to the Compliance Committee.

Reporting and Enforcement

Any employee who believes a required screening was missed, that a screening result was ignored, or that an excluded person is working in connection with federally or state-funded services must report it through the channels described in POL-003 (Compliance Reporting, Investigation, and Resolution), including the anonymous web form and the compliance ticketing system. Reports are investigated under POL-003 and its Compliance Ticket Management SOP. Confirmed violations, including failure to run required checks or failure to disclose an exclusion, may result in disciplinary action up to and including termination, and for contractors and vendors, termination of the relationship. ABAS will not retaliate against any person who reports a concern in good faith.

Forms Reference

The register supporting this policy is maintained by the Director of Operations:

Vendor exclusion screening is recorded in the Vendor & Contract Arrangements Register (REG-002). Its exclusion-screening record captures, for each vendor, the last-screened date, the lists checked (LEIE, SAM.gov, and the applicable state Medicaid exclusion list), the result, and the screener, supporting both pre-engagement screening and the monthly re-check of active vendors (Section Procedures, Steps 1–3). REG-002 also serves POL-005 (Anti-Kickback Statutes).