How does OIG Exclusion Work? Your Questions Answered

Posted by Frank Strafford on November 4, 2016 in Background Screening, Exclusion Screening, Exclusions, OIG Penalties,
How does OIG Exclusion Work
Solution Concept Human Resource on Blackboard

The Office of the Inspector General (OIG) maintains a list of those individuals and identities who are prohibited by federal law from participating in Medicare, Medicaid, and all other federal healthcare programs. How does this List of Excluded Individuals and Identities (LEIE) work?

 

What causes an individual to be added to the OIG’s LEIE, and excluded from serving federal healthcare patients?

Most individuals who are on the exclusion list have been involved in some kind of fraud, sometimes with regard to Medicare or Medicaid, but other seemingly less serious offenses, may OIG’s LEIEput an individual on the LEIE as well. Fraud related exclusions are called “mandatory exclusion,” while non-fraud related exclusions are called “permissive exclusions.” Some grounds for permissive excluded individuals to be added to the LEIE may be the provider’s abuse or neglect of a patient, as well as his or her defaulting on federal student loans, just to name a few. Depending on the cause for exclusion, individuals may apply for reinstatement — that is, removal from the OIG list of excluded individuals — when the designated period of their exclusion is over.

Note that applying for reinstatement with the OIG does not mean removal from other federal exclusion programs.

What happens to the individuals on the OIG exclusion list?

Federal healthcare programs, including but not limited to Medicare and Medicaid, will not pay for the goods and services provided by OIG excluded individuals. Moreover, the federal programs may cut off funding to workplaces that employ (or contract) individuals on the OIG exclusion list.

How do I use the OIG LEIE to screen my employees?

How do I use the OIG LEIE to screen my employees

There are many ways you can access the exclusion database, beginning with the exclusion database that you can search online or download to your own computer yourself, and extending to services that help you screen both potential employees and veteran workers. Programs for regular background checks should be in place to ensure that your employees comply with OIG standards and any healthcare facility that discovers that an employee is an OIG excluded individual must report it to the OIG immediately.

Am I obligated to run background checks on my employees to see if they’re on the OIG exclusion list?

There is no formal regulatory requirement for businesses to screen potential employees via the LEIE, but the employment of individuals on the OIG exclusion list can endanger patients and federal funding. For the same reason, the CMS strongly recommends to perform monthly background checks of existing employees and contractors, in case one of them is on the list of OIG exclusions.

One way to make sure that your company is compliant is to enlist a company that specializes in the LEIE, both in terms of its requirements and in screening employees and entities for the exclusion status.

Please refer to this resource for more helpful information on OIG Exclusions and LEIE searches.

About Frank Strafford

About Frank Strafford

Related Articles

Iowa MFCU’s Strong Performance in ...

September 19, 2022

In June, 2022, the OIG issued its 2021 Iowa Medicaid Fraud Unit (MFCU) Inspection Report. The OIG inspection revealed a MFCU unit with exceptionally strong case outcomes over the 2019-2021 period comp...

In the Mind of the OIG

October 21, 2015

Robert DeConti, assistant inspector general for legal affairs at OIG, and Lisa Re, chief of the OIG Administrative and Civil Remedies Branch, explain why some get excluded...and others don't. OIG enfo...

SAM.gov Continues to Evolve

March 1, 2021

Since 2017, the General Services Agency’s (GSA) Integrated Award Environment program office has been working to consolidate all related procurement tools into a single modernized online environment....

Understanding OIG Exclusions

OIG Exclusions Screening Process

Exclusion FAQS

Quick OIG Exclusion Basics

Employing Excluded Individuals

Consequences to Employing an Excluded Individual

OIG Compliance Law

Laws and Publications on OIG Compliance

More Compliance Resources

Our Culture

We build the best, so you can perform at your best.

Trusted for Good Reason

  • ✓ Guaranteed accurate
  • ✓ Certified Secure
  • ✓ Audit Proof
  • ✓ Feature-rich reporting
  • ✓ Round the clock real-time-data
  • ✓ Processing fully automated

Security First

  • ✓ Cloud hosted
  • ✓ Encrypted data
  • ✓ Real-time backups

Trusted for Accuracy

  • ✓ Physical security
  • ✓ Restricted access
  • ✓ Single sign-on
  • ✓ Password security
  • ✓ Certified secure
  • ✓ Cross checking

HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY

5

60%

Average workload reduction by implementing the Streamline Verify program

5

10K

Establishments trust Streamline Verify nationwide

5

2011

Serving the healthcare industry’s unique compliance needs since 2011

5

24X

Setting standards with hourly synchronization to primary source data