If you work in health care, you are certainly no stranger to the terms “OIG “ and “exclusion.” In fact, you have likely had a nightmare or two on the subject, especially if you work in compliance (does the grim reaper come to mind?). While the terms are a hot topic in the health care industry, there is still a lot of mystery surrounding the OIG exclusion process and what is “oig exclusion list.” Keep reading to discover 5 not-so-obvious things you should know about OIG exclusions:
1. An individual can be excluded for defaulting on federal student loans.
In more technical terms, this is referred to as a HEAL (Health Education Assistance Loan) exclusion. Although steps are taken prior to excluding the individual to ensure repayment, failure to resolve the indebtedness declares the individual as in default.
2.) To be removed from the OIG exclusion list, an individual MUST apply for reinstatement.
While this seems somewhat obvious, you’d be surprised how enigmatic this concept really is to most people. Note that reaching the “end date” of your exclusion term does NOT remove you from the OIG exclusion list. Even if your exclusion term expired 5 years ago, you will still be considered excluded until you apply for reinstatement. Click here for more information regarding the reinstatement process through the OIG.
3.) Applying for reinstatement through the OIG will not reinstate you through other excluding bodies.
Remember there are other exclusion sources outside of the OIG. SAM.gov, another federal excluding body, as well as 34 states, also issue exclusions. If excluded by the OIG and another excluding body, you must apply for reinstatement with each to no longer be considered excluded.
4.) Sanctions pertaining to license revocation or suspension can be a precursor to exclusion.
A common trend leading to exclusions is the issuance of a disciplinary sanction on the individual involving the revocation or suspension of their health care license. This is an indicator that the individual could be on their way to becoming federally excluded, so proceed with caution.
5.) States Take their Sweet Time Reporting to the OIG.
If a state takes action to exclude an individual or entity from participating in federal health care dollar reimbursement, it is safe to assume the states would quickly, and efficiently, report to the central federal OIG List of Excluded Individuals and Entities (LEIE) database. However, surprisngly, states seem to take their time when it comes to sharing their exclusion data.
Why is this important? The OIG advises that all health care companies that employ or conduct business with a third party vendor activate monthly searches of the List of OIG exclusions. If an individual or entity is excluded at the state level, the record is supposed to be shared with the OIG LEIE so that it is not missed by an employer. But that is not always the case.
6.) System Award Management (SAM) is the EPLS go-to.
The General Services Administration (GSA) administers all procurement databases, including SAM. SAM now houses the old EPLS. So SAM is the GSA go-to!
7.) New proposed rules broaden the authority of the OIG to exclude individuals or entities convicted of an offense in relation to the obstruction of an audit.
As the OIG continues to broaden and enforce their exclusion authority, it is vital to remain informed, and up-to-date, on the ever-changing rules and regulations to ensure compliance.
Any thoughts? Comment Below!
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Written by Michael Rosen, ESQ
ProviderTrust Co-Founder, firstname.lastname@example.org
Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as: Inc Magazine’s Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year
Connect with Michael on Linkedin
This post was orginally published August 24, 2014 and has been completely revamped and updated for accuracy and comprehensiveness.