OIG Exclusion List Check

∞ OIG EXCLUSION LIST SPOTLIGHT ∞

When Congress enacted the Health Insurance Portability and Accountability Act and the Balanced
Budget Act of 1997, it expanded the federal government’s authority to combat fraudulent activities in
federally financed health care programs. It is with this authority that the Department of Health and
Human Services Office of Inspector General (OIG) developed and maintains the List of Excluded
Individuals & Entities (LEIE).

The OIG Compliance Guidelines for health care providers and health care entities dictates that
they examine the OIG List of Excluded Individuals/Entities prior to hiring or contracting with
individuals or entities.

CI’s OIG EXCLUSION LIST inquiry identifies individuals and entities excluded from participation in
Medicare, Medicaid and other federally financed health care programs. Subjects are examined by
name and results found include specialty, exclusion type and date of exclusion.

The effect of an OIG exclusion from participating in federally financed health care programs is that
no federal health care program payment may be made for any items or services: (1) furnished by
an excluded individual or entity, or (2) directed or prescribed by an excluded physician. The
prohibition also extends to payment for administrative and management services not directly
related to patient care, but that are a necessary component of providing items and services to
federally financed health care program beneficiaries.

The practical effect of an OIG exclusion is to preclude employment of an excluded individual in any
capacity by a health care provider that receives reimbursement, directly or indirectly, from any
federally financed health care program.