The Office of Inspector General plays an important role in ensuring the integrity of healthcare programs in the United States. It is a necessary part of US healthcare services and it improves the accountability and performance of the professionals working in the healthcare sector. The crucial work of OIG is exclusion list, which identifies the individuals or entities barred from working in healthcare programs due to their involvement in abuse, fraud, and other misconduct. In this blog, we will delve into the information about the OIG Exclusion list and explore some unknown and important details about them.
What is the OIG Exclusion List?
The OIG Exclusion list is also known as the List of Excluded Individuals and Entities (LEIE). It is a database of individuals and entities who have been barred from federal healthcare programs such as Medicare, Medicaid and Children’s Health Insurance Program. The list is maintained by OIG and it gets updated every month without any mistakes. Every second week of the month is selected to update the LEIE to maintain the records of individuals and entities who are OIG Check and OIG Excluded. For the unversed, the Department of Health & Human Services has been imposing the exclusions since 1977 but the OIG started doing it from 1981.
The authority of exclusion for OIG is included in the Social Security Act §1128. Fines related to the misconducts and offenses are mentioned in 42 U.S. Code § 1003.210. CMPs apply to many infractions a penalty of not more than $10,000 for each individually or non-individually billable item or service provided, furnished, ordered or described by an OIG excluded individual or entity.
Why is OIG Check Important?
The OIG maintains the list to identify the misconducts and it is crucial to get an OIG check done because it gives you the authority to work with a verification from an official. The OIG exclusion list prevents fraudulent and bad impacts on healthcare. It saves the lives of the patients, healthcare workers and hard-earned money of the taxpayers. This also encourages healthcare providers to work without any hesitation by giving them a green signal of being an honest and successful healthcare provider. The time-span of OIG check reduces the chances of any harm because the list gets updated on a monthly basis.
What are the penalties for OIG Excluded Individuals/Entities?
The crucial penalty for the OIG Excluded Individual and Entity will be that the person or entity will not be able to make any payment for ‘any items or services furnished, ordered or prescribed by an excluded individual or entity.’ This prohibition mainly applies to the excluded person but it also includes the individual/entity who employs or contacts the excluded person, any hospital or healthcare provider connected to the excluded person and anyone else.
What are the reasons for OIG Exclusion?
The OIG Exclusion can be imposed for a number of reasons but there are two important pathways which have their own consequences and exclusion period:
Mandatory Exclusions: This type of inclusion includes some primary and crucial misconducts such as Medicare or Medicaid fraud, any other misconducts related to the delivery of items and services under Medicare, Medicaid, SCHIP or other healthcare programs. Along with them, the mandatory exclusions include felony offenses related to health-care related fraud, theft, and or other misconduct related to financial loss, unlawful manufacture, distribution, prescriptions and patient abuse.
Permissive Exclusions: These exclusions include discretionary offenses and a broad range of non-healthcare-related misconducts, crimes. In these cases, provoking factors are reviewed during OIG audit and investigation. These exclusions include fraud in a program backed by a federal, state or local government; misdemeanor judgments relating to the unlawful manufacture, distribution, prescription; submission of fraudulent claims to a federal healthcare program; defaulting health education scholarship and controlling an officer or employee.
How to check the Exclusions List Prepared by an OIG?
The database is available for the public to search.It includes the features of Social Security Number (SSN), Employer Identification Numbers (EIN), Date of Birth (DOB) to make the search effective for any individual or entity searching their name on the list.
The file including the entire LEIE is also available for download.
Conclusion
The OIG is an integral part of the United States healthcare program to maintain the discipline and avoid any harm to the patient or healthcare provider. It is crucial for every individual or healthcare provider to check for the OIG Exclusion list as it updates monthly. The OIG Exclusion is also important to keep the offensive people away from the healthcare sector to ensure total security and reliability. The data is available online so it is not hard for any individual or entity to check their name in the list. The important tip to keep yourself safe from the exclusion list is to avoid doing any misconduct mentioned in the ‘Mandatory and Primary Exclusions.’
