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.

How Often Should I Check the OIG Exclusion List?

The Office of Inspector General (OIG) recommends checking the exclusion list at a minimum monthly frequency, as names may be regularly added or removed from the list. Regular screening ensures that your staff remains in compliance with federal healthcare program requirements and that your organization maintains eligibility to serve Medicaid, Medicare, and other government healthcare beneficiaries. By diligently reviewing the OIG exclusion list, healthcare providers can proactively identify and address potential issues, reducing the risk of fines, penalties, and reputational damage associated with employing or contracting with excluded individuals or entities.

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.

Medicare Legal Exclusions by OIG

So, what does it mean to be on the exclusion list? It’s important to know what the 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 health programs. This list is called the LEIE or List of Excluded Individuals/Entities. The public, patients and everyone in the health care industry can thereby stay informed about exclusion and take necessary action after investigations.

The OIG takes into consideration sections of the Social Security Act in order to determine whether or not someone will face exclusion from the programs (including Medicare). When they decide an individual or entity should face exclusion, they will send them a Notice of Intent to Exclude. This doesn’t mean there is an exclusion. 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 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 an explanation of 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 exclusions list, it means that you won’t be able to participate in health care programs such as Medicare and Medicaid any longer.

It is possible to be reinstated and get off the Exclusion List. It takes some work, but it can be done. First you would appeal it to an 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. Specialized attorneys offer their services and can help with the appeals. A health law attorney who knows health law is the best bet to give you the best chance of winning an appeal.

If an individual has exclusion under section 1156 of the Social Security Act, he or she can request a hearing if program 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 health professionals delivering services. 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 Exclusion List and not allowed to participate in any way with a Federal health care 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 (OIG). It includes all entities or individuals who are not allowed to participate in any Federal health care 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 an Exclusion 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 an Exclusion 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 health care 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 OIG List of Excluded Individuals/Entities (LEIE)?

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 health care 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

Have you been placed on the Office of Inspector General (OIG) Exclusion List (LEIE) and would like assistance in removing yourself from the List?  Chelle Law assists health care professionals in either fighting the Notice of Intent to Exclude or requesting the removal of the health professional if they are currently on the exclusions list. Legal representation is your best choice if your desire is to be removed.

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.