Medicare Exclusion List

A list of healthcare providers is kept by the Office of the Inspector General (OIG) of the United States Health and Human Services Department known as the Medicare Exclusion List. In this Medicare Exclusion List are listed those who are not permissible to contribute in Medicaid, Medicare, and numerous other programs of health care that are operated federally.

Everything You Need to Know About the Oig Exclusion List

In 1977 the federal government had circulated a list of providers who are excluded from getting payments from the government after committing some faulty acts. Currently, the OIG LEIE is managed by the office of the Inspector General at Health and Human Services. The OIG LEIE is an essential element of compliance for the healthcare organizations; furthermore, the OIG doesn't issue warnings. It also consists of Compliance Hotline where people can report any kind of compliance

What is OIG LEIE, and why is it essential to search for it?

As per the OIG Exclusion Search, it provides data to the health care industry and the public about the people and entities excluded currently from participation in Medicaid and other Federal health care programs. It is easy to search for LEIE after the list provided from OIG Exclusion Search as it is updated regularly on the official portal of the OIG.

The most crucial reason for the OIG Exclusion Search is to ensure that the organization should hire potential employees who aren't on the list currently. If certain entities or individuals are on the list, they are subject to specific penalties.  Having excluded people on board causes a severe problem for the organization.

What are the effects of Medicare Exclusion List?

The Medicare Exclusion List leads to two types of exclusion, including permissive and mandatory. Ideally, the necessary exclusions are ordered by the law, and OIG requires to exclude an individual and entity when they are caught to commit some crimes, including Medicare fraud or abuse. On the other hand, permissive exclusions provide OIG discretion over exclusion. The offenses under permissive exclusions are on a misdemeanor level. 

One of the minimal effects of exclusion includes denial of payments by a federal health organization; it consists of any items or services ordered, furnished or prescribed by an excluded entity or individual. 

What are the exceptions of Medicare Exclusion List?

Ideally, the OIG grants minimal exceptions. The exceptions covered include no payment by the federal health care programs and providers who furnish services or items, especially to non- national health care beneficiaries. It is a challenging landscape to navigate, so one should take specific precautions will working with excluded entities.

List of Excluded Individuals and Entities (LEIE)

 Health care professionals and businesses need to take care of an advanced set of federal and state laws and regulations also as profoundly negative consequences because of failure to suits these laws. One of these consequences is the HHS OIG

List of Excluded Individuals and Entities (LEIE).

 The OIG Exclusion Search consists of people and entities who are excluded from participating in federal healthcare programs. Under Sections 1128 and 1156 of the Social Security Act provide authority to the OIG Search to exclude individuals and entities from federal health care programs like Medicare and Medicaid. Individuals may be excluded for reasons that fall under one among two categories: permissive or mandatory. However, exclusions are applied broadly in both categories.

1.       Mandatory exclusions require the OIG, by law, to exclude from participation in all Federal health care programs. Examples of infractions considered for mandatory exclusion: conviction of healthcare program-related crimes, conviction relating to patient abuse, felony conviction relating to health care fraud, or felony conviction relating to a controlled substance.

2.       Permissive exclusions are discretionary. Although not required by law, OIG Exclusion Search may exclude individuals and entities for reasons such as misdemeanor convictions related crimes health care fraud, misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances, and submission of false or fraudulent claims to a Federal health care program among others.

3.       OIG Exclusion Search- HHS prepares and maintains LEIE for the precise purpose of identifying persons or entities that are excluded from the Medicare Program by its Inspector General. The database is updated monthly. The LEIE is often accessed on the OIG’s website and up to five names can be searched at a time. OIG Search also can be downloaded for searching purposes. Matches can then be verified individually by

4.       Social Security Number. -If you’re checking out quite a few individuals or entities, it’s best to download the entire LEIE file and use the CSV file or a database program to perform the searches. There are also automated OIG exclusions monitoring services that will cross-reference your employee roster with the LEIE every month,automatically. These services will then alert administrators if there’s a match so they can investigate further.