OIG Exclusion Search.

The mission of the Office of Inspector General (OIG) is to safeguard the Department of Health & Human Services (HHS) programs and the wellbeing of its beneficiaries. The OIG has the authority to prohibit individuals and entities from federally subsidized health care programs. They also maintain an exclusion list of all current individual and entities prohibited from participating called the List of Excluded Individuals/Entities (LEIE).

Employers are encouraged to run an OIG Exclusion Search to periodically monitor their current employees. This will be to ensure that they do not appear on the List of Excluded Individuals/Entities (LEIE) as it might be detrimental to the organization’s image and operations.

Exclusions are enforced for numerous reasons:

• Mandatory Exclusion – Any individual or entity who is convicted of the following crimes is required by law to be excluded from participation in all Federal health care programs:
  
  • Medicare or Medicaid fraud
  • Any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other state health care programs
  • Patient abuse or neglect
  • Felony convictions for other health care-related fraud, theft, or other financial misconduct
  • Felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substance

• Permissive Exclusion – This exclusion allows for discretion on behalf of the OIG for individuals and entities convicted of certain misdemeanors:
  
  • Related to health care fraud other than Medicare or a state health program
  • Fraud in a program (other than a health care program) funded by any Federal,  State or local government agency
  • Relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances
  • Suspension, revocation, or surrender of a license to provide health care for reasons bearing on professional competence, professional performance, or financial integrity
  • Provision of unnecessary or substandard services
  • Submission of false or fraudulent claims to a federal health care program
  • Engaging in unlawful kickback arrangements
  • Defaulting on health education loan or scholarship obligations
  • Controlling a sanctioned entity as an owner, officer, or managing employee