All You Need To Know About OIG Exclusion Database

What Is OIG Exclusion Database?

The OIG or Office of the Inspector General’s list of excluded individual/Entities (LEIE) offers info to the health care industry, patients and the public regarding individuals and entities currently excluded from taking part in the Medicare, Medicaid or other Federal Health care Programs.  You can easily choose Texas OIG Exclusion Search firms to look after every single step of exclusion search and other screening needs.

The Medicare and Medicaid Patient and Program Protection Act of 1987, expanded and revised OIG’s administrative sanction authorities by establishing certain additional mandatory and discretionary exclusions for various types of misconduct.

What is the extent and effect of OIG Exclusion?

The scope of exclusion is from all Federal health care programs such as -

•    Medicare

•    Medicaid

•    Any other plan or program that offers health benefits either funded directly or indirectly by the United States.

The effect that no payment will be made by any Federal health care program for any items or services furnished, ordered or prescribed by an excluded individual or entity. This prohibition is for the following-

• the excluded individual
• anyone who employs the excluded person or contracts with him
• any hospital for which the excluded person provides services

What if a claim is submitted from an excluded person?

If an excluded person or entity makes a claim, then;

• The may be subjected to civil monetary penalties (CMP) of $10,000 for each claimed item or service furnished during the period that the person was excluded.
• he may be subject to an assessment of up to three times the amount claimed for each item.
• he may be civilly liable under the False Claims Act for presenting a false or fraudulent claim for payment.

What exclusion databases should be checked?

A provider must screen the employees and contractors against its State exclusion database. There are states that maintain a separate database such as Texas OIG exclusion search, California exclusion search, and many others.

How often should the checks be done?

There is no statutory requirement for the exclusion database check, the OIG suggests that providers screen their employees, contractors, and volunteers for exclusion prior to employment or engagement and on a monthly basis to minimize risk.

Though the monthly checks are not required, OIG recommends it be done at this frequency as guidance. If done on a monthly basis, the providers are in a better position to defend situations in which excluded persons are discovered on their payrolls

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