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.