Why the OIG Exclusion List Matters for Your Healthcare Business

Healthcare has a high volume of paperwork, no matter the size of your practice (hospital, clinic, etc.). From managing patient files to processing claims through insurance companies to paying for utilities and supplies, it can be hard to keep track of the administrative duties in your office. One of those duties is verifying employee eligibility prior to their hiring; that’s where the Office of Inspector General (OIG) is involved

The OIG maintains an “Exclusion List OIG” of individuals who are ineligible to provide care to patients, thus protecting both patients and taxpayers.

What is the List of Excluded Individuals and Entities (LEIE)?

The List of Excluded Individuals and Entities (LEIE) is a "do not hire list" that identifies individuals, healthcare professionals or entities that have been excluded from federally funded health care programs. The Office of Inspector General (OIG), a component of Health & Human Service, is responsible for preventing and prosecuting fraud or abuse against the federal government.

The OIG maintains a list of individuals or entities that have been excluded from federally funded healthcare programs due to the inability or unwillingness to properly manage federal healthcare dollars (i.e., Medicare and Medicaid dollars). Once placed on the LEIE, individuals or entities are barred from participating in those federally funded health care programs.

How Does Someone Get Excluded?

People do not end up on this list for minor mistakes or typos. To get OIG excluded, an individual usually has to commit a serious offense. There are mandatory exclusions and permissive exclusions.

The most common reasons for being excluded include:

• Convictions for Medicare or Medicaid fraud.

• Patient abuse or neglect.

• Felony convictions related to healthcare theft.

• Felony convictions related to controlled substances (drugs).

Sometimes, people can also be excluded for defaulting on student loans or losing their medical license in a specific state. Essentially, if someone is OIG excluded, the government has determined they pose a risk to the financial integrity of the system or the safety of patients.

You may think to yourself, “Why do I need to check?” You trust your employees, right? The answer is that it comes down to money and liability.

If you employ a person who has been excluded by the OIG, there are no federal healthcare program dollars available to you for payment for any items or services those persons have provided you or your facilities. This applies to all items or services provided by excluded individuals, including but not limited to a doctor performing surgery, a nurse checking vital signs, or an administrative assistant entering billing codes.

If you use an excluded person to provide services in any of your facilities as outlined above, you will be required to reimburse the federal government for every dollar you received as payment for services associated with that excluded employee. The OIG will also impose large fines ranging from thousands of dollars for each claim submitted.

Keeping Your Practice Safe

The best way to handle this is to make checking the list a habit. Many businesses make the mistake of checking a new hire once and then never checking again. However, the OIG updates the list every single month. An employee who was safe in January could be on the list by February.

By understanding OIG exclusion and running monthly checks, you protect your bank account from fines and, more importantly, you protect your patients from bad actors. It is a simple step that keeps your business healthy.

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