Healthcare Providers and the OIG Exclusion List

Background

The federal Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded health care programs pursuant to section 1128 of the Social Security Act (and from Medicare and State health care programs under section 1156 of the Act) and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE).

Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties. As a consequence, to avoid liability, healthcare entities need to routinely check the LEIE to ensure that new hires and current employees are not on the excluded list.

Purpose of List

The LEIE is a tool to keep track of individuals who have been excluded from participation in federal healthcare programs due to crimes or convictions like fraud or patient neglect. But individuals who are placed on the list by the OIG don't stay there forever. Each exclusion comes with a different term, and when that term is up, individuals may apply for reinstatement (and removal from the LEIE database).
 
Reinstatement, however, doesn't occur automatically when the term ends. OIG-excluded individuals who wish to be removed from the Medicaid and Medicare exclusion list must go through a process to become employable in healthcare programs again.

How Do You Get on the List?

There are a number of ways a person can end up on the LEIE list ranging from student loan defaults to misdemeanor criminal convictions (even ones unrelated to healthcare) to out-and-out healthcare fraud, and everything in between. You can even end up on the list through a request of another federal agency.

Knowledge is Power

Knowing exactly when you are eligible for removal is not as easy a question as the OIG would have you believe. In the simplest of cases, it just means serving out the time of exclusion that was initially imposed. Unfortunately, it is becoming increasingly common for providers to be placed on the list without actually receiving notice. This means that you may not even know when, or for how long, you were placed on the list. It is very often the case that providers do not even know they are on the list until a prospective employer tells them they are not hireable because they are excluded.

More Roadblocks

Another serious problem is that removal from the list is often tied to the OIG getting some form of notice of eligibility from another federal agency. Which federal agency the notice comes from is not always easy to find out. Student loans are a great example of this. Unless you have settled your student loans with the Department of Justice, and notice of the settlement is sent to the OIG in a form the OIG deems sufficient (which it will not tell you), you are not eligible for removal.

The Bottom Line

The OIG exclusion list is a complicated regulatory program which requires experience and perseverance to navigate. It is highly recommended that you do not attempt to handle removal without qualified assistance. If your application is denied, even for hyper-technical reasons, you may be barred from reapplying for one full calendar year. Therefore, it is crucial that your application is complete and correct, and you are fully eligible for removal.