Compliance with the law is a must for every healthcare provider. The Exclusions List OIG is one of the best compliance tools available. For hospital administrators, doctors, and staffing agencies alike, it is important to know what constitutes OIG exclusion in order to protect your business from large monetary fines and legal repercussions.

What Is the OIG Exclusions List?

The Exclusions list is also referred to as the List of Excluded Individuals and Entities (LEIE). It is maintained by the U.S. Department of Health and Human Services; it contains the names of individuals as well as entities who have been excluded from participation in federally funded healthcare programs. This includes Open Federal Health Care programs, such as Medicare and Medicaid.

An individual or entity may be placed on the OIG exclusion list for a variety of reasons, including fraud or abuse of patients, problems with licenses, or other types of violations that threaten the integrity of federal healthcare programs. Length of exclusion may vary (from perhaps a few years to, in some circumstances, a lifetime). Length is often determined by consideration of how serious the offense was, as well as the factual circumstances giving rise to the exclusion.

OIG Exclusion Significance

Hiring or contracting with an excluded individual or entity can expose your organization to serious consequences. If you employ an excluded person, you could incur significant penalties because, under federal law, payments cannot be made for any items or services provided by excluded individuals or entities. Claims submitted to federal health care programs related to the work performed by excluded individuals will be denied; in addition, you may be required to return amounts you have received for those claims.

In addition to the financial impacts, which could total thousands of dollars, your organization could also incur civil monetary penalties of up to $10,000 for each item or service that is provided by an OIG excluded individual. If your organization is included in these penalties, it is very possible that your organization will be excluded from federal health care programs, which in turn could result in shutting down your health care business.

Who is Excluded from Federal Health Care Programs?

Individuals and organizations can be excluded from participation in federally funded health care programs under broad grounds, including but not limited to:

1. Felony conviction for committing or attempting to commit a healthcare-related crime (e.g., fraudulent bills);

2. Felony conviction for abusing, neglecting or exploiting patients;

3. Abusing, neglecting or exploiting patients; or

4. Being sanctioned by a licensing Board in one or more states.

All types of healthcare professionals and organizations (including physicians, physician assistants, nurses, pharmacists, hospital or practice administrators, clerks, billing specialists and others) may find themselves OIG excluded from all federal health care programs. None of these exclusions are limited to the clinical staff that provides the actual patient care; any person or entity who provides services which are reimbursed by federal health care programs can be excluded.

The OIG Exclusions List is easily accessible and totally free of charge. You can check the list using the OIG website, which has a public database that is updated once a month.

You may search either by the name of an individual or business, as well as by other information that will help identify the individual or business being searched. Searching for an individual on the OIG Exclusion List should take only a few minutes; however, it could save your organization from incurring significant costs associated with making an adverse employment decision.

Health care compliance professionals recommend performing a screening at numerous points in time: Before hiring employees or other contractors, when newly hiring employees or contractors (during the onboarding process), and through scheduled monthly screenings of current employees and contractors. In addition, many organizations conjoin their automated screening systems to cross-check their employee databases with the LEIE on a consistent basis.

Advice to Follow for Compliance

Having a strong compliance process involves creating written policies and procedures to screen against OIG Exclusions List (639 C.F.R. §751.140) for each employee hired or retained. It is important that you have a person(s) designated to perform these checks and keep records of screenings made.

You need to maintain records of when these screenings occur and their results. If you identify an individual listed on the Exclusion List, you will want to remove that employee immediately from providing goods and services that will be reimbursed by Medicare/Medicaid. You should seek advice from your attorney regarding how to proceed.

The training of your human resources department and your compliance department so that everyone understands the importance of screening for exclusions, is vital in creating a compliant environment with respect to your entire business. It needs to become a part of your corporate culture and not just a compliance checklist item.

Protecting Your Organization

The OIG Exclusions List exists to protect the integrity of federal healthcare programs and, ultimately, patients. By making exclusion screening a standard part of your compliance program, you protect your organization from financial penalties while contributing to a trustworthy healthcare system. Regular monitoring of the Exclusions List OIG isn't just about avoiding penalties—it's about maintaining the highest standards of care and ethical practice in healthcare.