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医疗保健并购:潜在的背景调查安全漏洞

国会于 2010 年颁布患者保护和负担得起的医疗法案 (PPACA)是自 1964 年医疗补助和医疗保险成立以来对国家医疗保健系统进行的最大规模改革。 PPACA 的目标是降低医疗保健的总体成本和通过使用各种补贴、税收抵免和授权来减少未投保个人的数量,并改善医疗保健提供过程和结果。

随着 PPACA 的不同要求的实施,医疗保健提供者期望从更多寻求医疗服务的患者中获得更多收入,但必须面临较低的利润率并雇用更多员工来满足需求。

行业整合——垂直整合和综合护理 
为了应对 PPACA 的挑战,保险和医疗保健提供商越来越多地转向行业整合,最近来自 Trinity Health、Cigna、WellPoint 和 Aetna 的并购证明了这一点。

对于保险公司而言,PPACA 将导致更多有既往疾病的个人获得保险,同时限制这些公司可以提高费率的金额。新投保客户的收入上限和额外护理成本使保险提供商寻求降低成本的新方法。这可能发生的主要方式是降低组织的管理成本,主要是通过合并和收购。

此外,在 PPACA 之后,责任医疗组织 (ACO) 正在形成,其中医疗保健提供者将不再仅根据所执行的服务和程序获得补偿。相反,他们根据这些服务的质量和结果获得奖励。

例如,心脏病专家进行成功的心脏手术可能还不够。专业人员可能还必须与患者合作,以帮助预防未来的并发症,这反过来又有助于降低医疗保健成本。这种对患者治疗结果的强调将导致综合护理的增加,也可能推动兼并和收购增加的趋势。

背景筛选:州和联邦
监管格局 面对 PPACA,合并或收购期间的联邦和州监管格局似乎是一个拼图游戏。在这些变化中,一些关于员工背景调查的规定有时似乎相互冲突,让那些希望保持合规的人感到困惑

此外,如果参与并购的公司中的一个或两个在其筛选程序中存在差距,则不合规的风险可能会被放大。当新的团队成员因合并或收购活动而成为组织的一部分时,入职团队确定是否需要进行新的背景审查仍然很重要,如果需要,进行此类新审查——即使是对资深员工或志愿者

如果组织的员工筛选计划存在任何差距,则这些差距在合并或收购过程中可能会扩大,这可能会使新合并的组织更容易受到处罚、罚款、诉讼和其他相关风险的增加。

在医疗保健行业发生并购之前,参与方必须评估另一家公司的员工筛选过程,而不是假设它是彻底和合规的。鉴于联邦政府向医疗保健系统注入的资金数量,合规审查和民事罚款的数量可能会增加。

为了弥补合并或收购中可能发现或出现的潜在筛选差距,组织应评估是否对新收购的员工执行了这些“最佳实践”检查,并考虑将其添加到筛选计划中:

  • 使用信誉良好的 SSN Trace 服务识别与个人社会安全号码 (SSN) 相关的姓名和地址。

  • 确定个人在与其地址历史相对应的司法管辖区是否有犯罪记录历史(例如县刑事、重罪和轻罪记录搜索)。

  • 通过进行可能有助于识别其他潜在犯罪记录数据的额外搜索(例如 观火的秒查服务)来扩大对个人犯罪历史的调查。

  • 通过检查个人当前或过去居住州的登记册或进行全国性搜索(例如全国性犯罪者登记册搜索)来识别已登记的性犯罪者的记录

  • 确认申请人或雇员是否已被制裁或排除参与联邦和州医疗保健计划(例如FACIS ® 1M 级搜索)。


  • Patient Protection and Affordable Care Act (PPACA), enacted by Congress in 2010, is the largest overhaul of the nation’s healthcare system since the formation of Medicaid and Medicare in 1964. The PPACA’s goal is to reduce both the overall cost of health care and the number of uninsured individuals through the use of various subsidies, tax credits and mandates, as well as improve the health care delivery process and outcomes.

  • As the different requirements of the PPACA are implemented, health care providers expect increased revenue from more patients seeking medical services but must face lower profit margins and hire additional staff to meet the demand.

  • Industry Consolidation – Vertical Integration and Integrated Care 
    To meet the challenges of the PPACA, both insurance and health care providers are increasingly turning to industry consolidation which is evidenced by recent mergers and acquisitions from Trinity Health, Cigna, WellPoint, and Aetna.

  • For insurance companies, the PPACA will result in more individuals with pre-existing conditions being insured, while at the same time capping the amount by which these companies can increase their rates. The capped revenue and additional cost of care of the newly insured clients is making insurance providers seek new ways to lower costs. The primary way this will likely happen is by reducing organizations’ administrative costs, primarily through mergers and acquisitions.

  • Additionally, Accountable Care Organizations (ACOs) are forming in the wake of the PPACA where health care providers will no longer be compensated solely based on services and procedures performed. Instead, they are rewarded based on the quality and outcomes of those services.

  • For example, it may not be enough for a cardiologist to perform successful heart surgeries. The professional may also have to work with the patient to help prevent future complications, which will, in turn, help lower health care costs. This emphasis on the outcomes of patient treatment(s) will result in an increase of integrated care and may also fuel the trend of increased mergers and acquisitions.

  • Background Screening: The State and Federal Regulatory Landscape
    In the face of the PPACA, the federal and state regulatory landscape during a merger or acquisition can seem like a jigsaw puzzle. Amidst these changes, some of the regulations regarding employee background checks sometimes seem to conflict with one another, making it confusing for those who wish to remain compliant.

  • In addition, if either or both of the companies involved in the merger or acquisition have gaps in their screening program, the risks of non-compliance may be magnified. When new team members are made part of an organization as a result of merger or acquisition activity, it remains important that the onboarding team determine whether new background screenings are required and, if so, conduct such new screens – even on veteran employees or volunteers.

  • If an organization has any gaps in their employee screenings programs, those gaps are at risk of expanding during a merger or acquisition, which could make the newly combined organization more vulnerable to increased penalties, fines, lawsuits and other related risks.

  • Before a merger and acquisition occurs in the health care sector, it’s vital for each party involved to evaluate the employee screening process of the other company rather than assume that it’s thorough and compliant. Given the amount of funding the federal government is injecting into the health care system, there will likely be an increased amount of compliance scrutiny and Civil Monetary Penalties.

  • To close potential screening gaps that may be identified or arise in connection with a merger or acquisition, organizations should evaluate whether these “best practice” checks were performed on newly acquired employees and consider adding them to their screening program:

  • Identify the names and addresses associated with an individual’s Social Security Number (SSN) using a reputable SSN Trace service.

  • Identify whether an individual has a criminal record history in the jurisdiction(s) corresponding to their address history (e.g. County Criminal, Felony and Misdemeanor Records Search).

  • Expand the investigation of an individual’s criminal history by conducting additional searches that may help identify additional potential criminal records data (e.g. HireRight Widescreen Plus™ service).

  • Identify records for registered sex offenders by checking the registries of an individual’s current or past states of residence or by conducting a nationwide search (e.g. National Sex Offender Registry Search)

  • Confirm if an applicant or employee has been sanctioned or excluded from participating in federal and state health care programs (e.g. FACIS® Level 1M Search).

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