The U.S. Department of Health and Human Services Office of Inspector General (OIG) has been at the forefront of our nation’s efforts to fight fraud, waste, and abuse in Medicare, Medicaid, and more than 100 other HHS programs. OIG develops and distributes resources to assist the health care industry in its efforts to comply with U.S. fraud and abuse laws and to educate the public about fraudulent schemes so they can protect themselves as patients and report suspicious activities.
OIG has the authority to exclude individuals and entities from Federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud. Those that are excluded cannot receive any payments from Federal health care programs for any items or services they provide, order, or prescribe. An individual or entity that is excluded by OIG from one program means they are automatically excluded from all 100+ HHS programs.
OIG maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE). The LEIE is updated monthly and any organization who hires or employs an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). To avoid CMP liability, health care organizations should routinely check the LEIE to ensure that new hires and current employees are not on it.
There are two types of OIG exclusions: Mandatory Exclusion and Permissive Exclusion. Mandatory exclusion is enforced by law and requires the OIG to exclude an individual or entity when a conviction for committing a felony crime involving Medicare or Medicaid fraud occurs, for felony offenses or convictions related to a state or Federal health care program, for felony convictions related to controlled substances, or for convictions of patient neglect or abuse. For permissive exclusions, the OIG has discretion on whether or not to exclude the individual or entity. The offenses prescribing permissive exclusions are on a misdemeanor level.
The OIG exclusion list is a vital source to check when screening and monitoring your provider population; your entities and individuals who serve patients. Increasing patient safety and serving the beneficiaries of these Federally funded health care programs is the purpose of maintaining these lists. Health care organizations can support OIG efforts to reduce fraud, waste, and abuse by carefully checking the OIG exclusion list on an ongoing basis and reporting any suspicious activities.