The U.S Federal Government's Office of Inspector General is responsible for taking on Medicare fraud head on. The results of those efforts yielded the OIG exclusion list. The LEIE, or "List of Excluded Individuals and Entities" is a constantly-updated list that includes those parties who have inappropriately abused and/or taken advantage of Medicare and Medicaid programs. When an individual lands on either this list or one of the other exclusion databases, that person's ability to participate as a healthcare provider in any program funded by the federal government is revoked. But there are two different types of OIG exclusions to be aware of, Mandatory and Permissive, and we'll be discussing Mandatory Exclusions here:

In context to the OIG exclusion list, Mandatory Exclusions are given as penalties for health care violations associated with fraud, abuse of patients, crimes and/or unlawful distribution of controlled substances. By law, the Office of Inspector General is required to exclude any party or parties - including individuals or entities - that are convicted of such crimes for at least 5 years.

If an individual or entity lands on the OIG exclusion list, Federal healthcare programs may not pay for an item of service ordered, furnished or prescribed by that party. This cutoff includes medication subscriptions as well as management and/or administrative services provided by the excluded individual.

It's extremely important for any organization within the healthcare field to protect against hiring or employing any excluded individual or entity. Avoiding Civil Money Penalties (CMP) plays an integral role in protecting the long-term and financial vitality of an organization. If your organization needs assistance in identifying individuals on the OIG exclusion list or need to redirect your limited human resources to less tedious but still important tasks, don't hesitate to call us so we can help assess your needs.