How does OIG Exclusion Work? Your Questions Answered

How does OIG Exclusion Work? Your Questions Answered
How does OIG Exclusion Work

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 employeesThere 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.

About Frank Strafford