Required fraud, waste & abuse screenings and notification

Federal health care programs, including Medicare and Medicaid, are generally prohibited from paying for any items or services furnished, ordered or prescribed by excluded individuals or entities. Priority Health has adopted these guidelines across all lines of business.

In accordance with OIG requirements, you should conduct monthly screening of your employees against their List of Excluded Individuals and Entities (LEIE), the System of Award Management at Sam.gov, and all other federal and state exclusion lists.

When to notify Priority Health

In addition to screening for excluded individuals and entities, as a participating provider you agree to provide timely notice to Priority Health if your office receives the following notifications:

  • Any malpractice suit, arbitration or settlement arising out of your professional services, causes of action, indictment or criminal conviction;
  • Any notices of exclusion (pending or final) from Medicare or any state or federal health care programs;
  • Any changes in licensure;
  • Any changes in the status of provider's privileges at any hospital.

We know you share our commitment to combating fraud and abuse and we look forward to our continued collaboration as we strengthen our efforts to identify excluded parties. If you have questions about our Fraud, Waste and Abuse (FWA) program, email us at SIU@priorityhealth.com or call us at 616.464.8152.