Everything You Need to Know About the OIG Check and Exclusions List OIG

When we go to a doctor or a hospital, we trust that the people taking care of us are honest, qualified, and safe. But how does the government ensure that healthcare providers are following the rules? The answer lies with a government agency called the Office of Inspector General (OIG).

For anyone working in healthcare, human resources, or medical administration, understanding the "OIG Check" is not just a suggestion—it is a requirement. Let’s break down what these terms mean in simple language and why they are so important.

What is an OIG Exclusion?

The Office of the Inspector General has a function that is to protect the federal healthcare programs, such as Medicare & Medicaid, from being taken advantage of through fraud and misconduct. If an individual or business violates these rules established by these programs, the OIG has the ability to exclude them from being able to participate in federal healthcare programs in the future, this is known as an OIG Exclusion.

OIG Exclusions are like being put into the "penalty box" in sports but much worse; once someone has an OIG Exclusion, they will not be able to legally receive any form of reimbursement from the federal government through any of its healthcare programs (i.e. Medicare, Medicaid, etc.). Thus, those with an OIG Exclusion cannot bill Medicare/Medicaid for any provided services.

Why Do People Get OIG Excluded?

You might be wondering what someone has to do to get on this "bad list." People or entities are OIG Excluded for several reasons. Some of the most common reasons include:

• Medicare or Medicaid Fraud: Billing for services that never happened or overcharging for services.

• Patient Abuse or Neglect: Harming patients in their care.

• Felony Convictions: Crimes related to healthcare, financial theft, or the distribution of controlled substances (drugs).

• License Revocation: If a state medical board takes away a doctor's or nurse's license, the OIG often excludes them as well.

Where do these names end up? The interpartnership general ("OIG") maintains a database of individuals and entities excluded from participating in federal health care programs, which is commonly known as the Exclusion List - OIG (formally the "List of Excluded Individuals/Entities - LEIE").

The Exclusion List - OIG is a public record that lists all current ban/denied persons and entities from receiving federal health benefits. It is updated on a monthly basis because new people may be added or reinstated to the list when their penalty period has expired.

Why the OIG Check is Mandatory

If you run a healthcare business, hire nurses, or manage a clinic, you must perform a regular OIG Check .This simply means searching your employees' names against the Exclusions List OIG database.

Why is this so strict? Because the government says that if you hire someone who is OIG Excluded, and that person provides items or services paid for by federal money, you are breaking the law.

It doesn’t matter if the excluded person is a head surgeon or an administrative assistant inputting billing codes. If federal money pays their salary, directly or indirectly, they generally cannot be on the exclusion list.

The consequences of neglecting to conduct staff screenings can be costly. When an employer hires an individual who has been excluded from participation in federally funded healthcare programs by the Office of Inspector General (OIG), that employer may be subjected to significant monetary penalties (civil monetary penalties or CMPs). The employer will likely be required to repay all funds received from Medicare and Medicaid as payment for the work performed by the excluded person, plus many thousands of dollars for each item/service that is being claimed. For a high volume hospital, these costs could easily escalate into multiple millions of dollars.

Staying Safe

Keeping compliance simple and straightforward is key! Follow these steps to stay safe:

Run the name of a prospective employee through the Office of Inspector General (OIG) Exclusions List prior to hiring them by performing a background check.

Conduct background checks monthly; just because someone passed the background check at the time of hire does not mean that they will not get into trouble down the road. The OIG updates their exclusion list on a monthly basis, and, therefore, you should conduct a monthly background check on all employees.

In addition to employees, you must check the  Exclusions List OIG  to ensure that any staffing agency or medical supply vendors you utilize are not on the list.

Conclusion

The OIG exists to keep patients safe and to stop tax dollars from being stolen through fraud. By understanding what an OIG Exclusion is and performing a regular OIG Check, healthcare organizations can protect their patients, their reputation, and their bank accounts. It is a simple step that makes the healthcare system safer for everyone.

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