How Often Do You Have To Check The OIG Exclusion List

How Often Do You Have To Check The OIG Exclusion List?

The OIG recommends Exclusion Lists be checked on a regular basis so providers do not in error hire those on the list of those excluded. The exclusions are constantly evolving with people added and removed continually, even daily so a regular check is important.

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The OIG’s Exclusion List

The OIG’s Exclusion List is a list of individuals and entities who are not allowed to work for or with any Federal health care program that delivers services such as Medicare or Medicaid. These exclusions are done for various reasons related to conduct in the field, some of which are:

  • Fraud
  • Patient abuse
  • Patient neglect
  • Program related convictions
  • License revocation

By excluding those from any Federal health care program it means that the exclusion is from Medicare, Medicaid, health care programs funded by the United States either directly or indirectly, and any entity that provides healthcare benefits and services funded by the United States.

A provider should check Exclusion Lists both Federal by the OIG and the state lists whenever hiring or contracting someone, such as a vendor or subcontractor. Then they should check each one of the employees or subcontractors against the list every month thereafter to see if any have been excluded. There are thirty-seven states which have state-based exclusion lists which should be checked.

Will I be Removed from the Inspector General List?

Depending on the exclusion by the OIG and the circumstance of it, some may have the ability to get reinstated and no longer be excluded from participating in certain health programs. This includes Federal programs and State programs too, such as State Medicaid. That person or entity would no longer be on the LEIE (List of Excluded Individuals/Entities). All exclusions would be discovered by an employer check when he or she checks the list and a person reinstated would no longer be on the list. This would include a Medicaid exclusion both state and Federal.

ALJ Appeal

The way a person can be reinstated is by going through an appeals process. The first appeal would be to the HHS Administrative Law Judge. From him the individual gets a decision that is based on the information he or she provides which shows why this type of exclusion in the health industry is not warranted. If the person does not get a positive response, he can go further with the appeal and turn to the HHS Departmental Appeals Board.

When no positive outcome there, it can be taken even further and the person can request a judicial review with the Federal Court. Following the exact requisites for these appeals can get an individual or entity removed from the exclusion list and able to participate in health programs funded by the Federal Government.

For any individual who intends to appeal and get reinstated, it is wise to contact an experienced attorney to help with the appeals in working out how to no longer be excluded. He knows what sort of information needs to be presented and how to present it. Hiring an attorney can mean the difference between being on the list and having your entire career affected, and not being on the list so you can move forward on the path you’ve chosen with providers of your choice.

What is a Screening?

So, what is an OIG screening? OIG screening is a process to verify whether or not a potential or current employee is on the Exclusion List and not allowed to participate in any way with a Federal healthcare program. There are no warnings or notifications issued by OIG that tell of who is excluded. Exclusion checks are something that needs to be done regularly.

The Exclusions List is compiled by the Office of Inspector General. It includes all entities or individuals who are not allowed to participate in any Federal healthcare program. This includes Medicare and Medicaid programs. The list is called the List of Excluded Individuals/Entities.

It is necessary for any provider to search the database maintained by the OIG, SAM.gov and any state Exclusion database. Each employee, contractor, subcontractor or new hire needs to be screened in this way, so that if they are on the Exclusion List, they are not hired or continued in employment. It is important to do this special exclusion monitoring regularly on everyone working for the provider.

How to Do a Screening

To do an exclusion screening, the employer puts the name of the employee and his birth date into the database. Anyone with a similar name will show, and the employer needs to verify whether it is his employee or not who is excluded. All variations of names need to be checked, including maiden names, as well as name diminutives (such as Jimmy instead of James). The results gotten can be cross-checked with the employee’s social security number and birth date. Being detailed oriented in monitoring is vital.

How Often Should You Do a Screening?

The screening should be done every month, as names get removed when appealed or in other circumstances. If it is impossible to do monthly, it should be done as often as possible. OIG updates the list monthly. Another option is to hire a vendor to do the screening. It is definitely a labor-intensive action, particularly for large companies. There are particular people that should be screened. The employer should be aware of these. The providers should screen:

  • Employees
  • Contractors
  • Vendors
  • Medical staff
  • Volunteers
  • Referring physicians and practitioners
  • Board members
  • Anyone else working closely with the provider

Severe Consequences for Having an Employee on the Exclusion List

There are severe consequences if someone excluded works with or for a Federal healthcare program. There can be fines for up to $10,000 for each service that the excluded party has provided. A provider can also face criminal consequences with can include being denied reinstatement to any Federal health care program. Providers who screen employees and subcontractors every month for exclusions will minimize liability. It is vital to screen for exclusions regularly.

How do I get rid of  the HHS Exclusion List?

So, many ask how do I get rid of OIG Exclusion list? When you find your name posted on the Exclusion List, you won’t be able to work with or for any health care program like Medicare or Medicaid. This list (List of Excluded Individuals/Entities or LEIE) means that you won’t be able to work for or in any of the Federal programs, and this can adversely affect your professional life as well as your personal life. It’s good to know how to get off the list and effectively get rid of the OIG Exclusion List in your life.

The Exclusions List is a list that is compiled by the Office of the Inspector General based on different sections of the Social Security Act. After studying these sections, this office decides whether they will exclude someone from accepting payments from Federal programs. This list itself is called List of Excluded Individuals/Entities.

Receiving a Notice of Intent to Exclude

After having decided that an entity or person should be excluded from working in or for Medicare or Medicaid programs or other similar health care programs, they will send a Notice of Intent to Exclude to the individual or entity. It is only a notice of intent and does not mean that they are automatically excluded. It gives them 30 days’ time to then gather everything they would need in order to explain why the exclusion should not be done. All the information will be carefully studied by the OIG before making a final decision so it must be complete as possible.

When you are going to be placed on the Exclusion List for participating in certain health care programs, the OIG will then send a Notice of Exclusion. When you receive it you will see an explanation of the exclusion and it will tell you how to appeal. See the date on the Notice as to when it was sent, because in 20 days from that time the exclusion will become effective.

Reinstatement Appeal Process

You can get reinstated by going through the appeals process. The first entity you appeal to is the HHS Administrative Law Judge. He will give a decision based on the information you send with the appeal. If it is not a positive decision and in your favor, you can appeal it further to the HHS Departmental Appeals Board. Even if they don’t give a positive response, you can still move further up the ladder and go to Federal Court for a judicial review.

Even though you must be proactive in getting through the appeals process, if you follow the already established procedures exactly how you are required to, you can get your name off the list and begin once again participating in health care programs funded by the Federal Government.

Legal Help

You can always contact an attorney with experience for legal help in this type of situation. An attorney can assist you through any process of appeal. At the attorney offices of Chelle Law, we work hard to support you in any appeal.