It’s important to have information about and to know what the OIG Exclusion List is as well as what it means to be on it. The Office of Inspector General keeps a list of all individuals or entities that are excluded from participating in Medicaid, Medicare, and other Federal health care programs. This list is called the LEIE or List of Excluded Individuals/Entities. The public, patients and everyone in the healthcare industry can thereby stay informed and verify who is on the list created by OIG. Federal health care must abide by the Social Security Act. To get help in appealing being included on the list, contact an attorney in an experienced law firm. You can find one at the website below.
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The OIG takes into consideration sections of the Social Security Act in order to determine whether or not they will exclude individuals from the health care programs run by Federal health care. When the OIG decides to exclude an individual or entity, they will send them a Notice of Intent to Exclude. This doesn’t mean they are excluded. The person who is receiving the notice can provide materials which the OIG will carefully consider before moving forward. The person who is receiving this notice from the OIG has 30 days to gather the information to explain why the exclusion is not warranted.
When you are going to be placed on the LEIE, the OIG will send a Notice of Exclusion with information about the details of the exclusion, as well as your appeal rights. Once this is mailed, the exclusion becomes effective 20 days later. When your organization or you have been put on the list, it means that you won’t be able to participate in Federal health care programs such as Medicare and Medicaid any longer.
Can You Remove Exclusion?
It is possible to be reinstated and get off the OIG List. It takes some work, but it can be done. First you would appeal the fact that the OIG excluded you to the HHS Administrative Law Judge. If getting an adverse decision there, you can then appeal it to the HHS Departmental Appeals Board also known as the DAB. If not happy with the final decision of the DAB, you can then get a judicial review done in Federal Court. If an individual was excluded under section 1156 of the Social Security Act, he or she can request a hearing if Federal program health services are being delivered to more than 50 percent of that person’s patients and in a rural area where there is a shortage of Federal healthcare professionals. When the individual has received a written notice of exclusion, he or she may file a request in writing for a hearing before the HHS Administrative Law Judge within 15 days of when the notice was received.
What is an OIG 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 OIG Exclusions List and not allowed to participate in any way with a Federal healthcare program or its services. There are no warnings, notifications or information issued by OIG that tell of who is excluded or included in an OIG exclusion from participating in healthcare such as Medicare and Medicaid. It is something that needs to be checked regularly. The OIG List is compiled by the Office of IG. 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 employer to search the database maintained by the OIG, SAM.gov and any state Exclusion database for health care services exclusions. 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 for any health organization that is federally funded. All exclusion lists should be checked regularly.
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. 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. In this way the employer will be able to find if the person is on a list of individuals or entities under exclusion of participating in Federal health care services. A plan should be worked out to do this regularly.
How Often Should You Screen Individuals?
The screening should be done every month, as names get removed when appealed or in other circumstances. If services providers could not do this monthly, it should be done as often as possible. OIG updates the list of exclusions 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. Any providers should be aware of these. The providers should screen the following for exclusions:
- Medical staff
- 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. Providers can also face criminal consequences that can include being denied reinstatement to any Federal health care programs or their services. An employer who screens employees and subcontractors every month will minimize liability. In that way he won’t hire any excluded individual or entity. Screening potential employees for exclusion saves a lot of headaches.
How do I get off of the List?
So, many ask how do I get rid of OIG Exclusion list? When you find your name posted on the OIG List and you are excluded, you won’t be able to work with or for any Gov. healthcare 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 available 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 (LEIE) in your life.
The OIG Exclusions List is a list that is compiled by the Office of the IG 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. All those excluded cannot work with or for any available federally funded health programs.
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, they will send a Notice of Intent to Exclude to the individual or entity named for exclusion. It is only a notice of intent and does not mean that they are automatically excluded. It gives them a period of 30 days 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 based on the Social Security Act. When you are going to be placed on the OIG List or the LEIE, 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 date the exclusion will become effective and you will be on the exclusions list.
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 does not come out 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 anyone must be proactive in getting through the appeals process for exclusions, if you follow the already established procedures exactly how you are required to, you can get your name off the list. You can always contact an attorney with experience helping with exclusions. An attorney can assist you through any process of appeal on the subject of being excluded.