What is the OIG Exclusion List Database?

The Office of Inspector General (OIG) was established in 1976 to safeguard the Department of Health & Human Services (HHS) programs as well as program beneficiaries from fraud, waste and abuse. The most familiar safeguard for our industry is the List of Excluded Individuals and Entities, or LEIE. The LEIE is published to inform the health care industry of any individual who is currently excluded, likely due to an offense related to fraud or abuse. Since the holidays are fresh on my mind, consider the following comparisons:

HHS
= The North Pole (Santa’s headquarters)
OIG = Santa Claus
LEIE = Santa’s “Naughty List”
Excluded Person = Child on Santa’s “Naughty List”
Exclusion = Lump of coal given to child for being on Santa’s “Naughty List”
Healthcare Industry = Parents of child on Santa’s “Naughty List”

Make sense? Basically, ending up on Santa’s “Naughty List” will get you a big lump of coal, not to mention Santa is going to tell your parents not to buy you any gifts until you are off the list.

What does it mean if you are excluded?

You may be surprised to learn that I have spoken to individuals who were actually excluded and had no idea what that meant in terms of their employment status. A few even expressed utter bewilderment at how they even became excluded in the first place. There are numerous ways you can become excluded, and the net only seems to be getting wider. You can check out a list of some of the most common reasons for landing on the OIG exclusion list here.

Getting back to the original point, no program (think Medicare and Medicaid) payment will be made for any items furnished or services performed by excluded individuals and entities. This does not just apply to those actually licensed and working with patients either, as the OIG website states that this extends to those indirectly involved as well (yes, this even means the cooks and housekeepers). This is why it is best practice to monitor ALL of your employees for exclusions. As the saying goes, better safe than sorry.

What happens if we employ or contract with an excluded person or entity and are audited?

Brace yourself for a plethora of fines. The employer is responsible for all fines associated with employing or contracting with an excluded person or entity. Note that the average fine for hiring or contracting with an excluded person or entity is $100,000 per person or entity, with more recent cases indicating a steady increase to roughly $197,000 per person or entity. Generally speaking, the amount typically assessed in fines if the OIG initiates the investigation (such as in an audit) is 3 times the amount of all damages. The silver lining lies in the recommended self-disclosure process, which, in most cases, reduces the multiplier to 1.5 times the amount of all damages. Click here for all you need to know about self-disclosing to the OIG.

You can always visit the OIG’s website at www.oig.hhs.gov for more information regarding the OIG exclusions database.

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Or You can talk with an expert about OIG Exclusion List Checks >>