The OIG List of Excluded Individuals/Entities (LEIE) is a database maintained by the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS). This list includes the names of individuals and entities that are excluded from participating in federal healthcare programs such as Medicare, Medicaid, and Tricare.
Exclusions are imposed on those found guilty of offenses such as Medicare or Medicaid fraud, patient abuse or neglect, and felony convictions related to healthcare. Individuals and entities on this list are barred from receiving payments for items or services rendered, ordered, or prescribed under any federal healthcare program. Healthcare organizations must ensure they do not employ or contract with anyone on this list to remain compliant with federal regulations.
Why is the OIG LEIE Important?
The OIG LEIE is a critical resource for several reasons:
Protecting Program Integrity: The LEIE helps protect the integrity of federally funded healthcare programs by ensuring that individuals or entities who have committed fraud or abuse are not allowed to participate in these programs.
Avoiding Penalties and Fines: Healthcare organizations that fail to check their employees, contractors, and vendors against the LEIE risk severe penalties, including fines of up to $10,000 per item or service provided by an excluded party. They may also be required to repay any payments made by Medicare or other federal programs for services rendered by excluded individuals.
Maintaining Program Eligibility: Organizations found to be employing or contracting with excluded individuals or entities risk exclusion themselves, which would result in a loss of eligibility to participate in federal healthcare programs. This exclusion could lead to significant financial and reputational damage.
Ensuring Ethical Practices: Using the LEIE to screen employees and contractors demonstrates a commitment to ethical practices and compliance with all applicable laws and regulations, which builds trust with patients, partners, and regulators.
How Does the OIG LEIE Work?
The OIG LEIE is an online, searchable database accessible to the public. Healthcare organizations can use this database to conduct exclusion checks by searching for individuals or entities by name, National Provider Identifier (NPI), or other identifying information. The LEIE is updated monthly, reflecting any new exclusions or reinstatements. You can do a free search using our Free Exclusion Search Tool.
How to Use the OIG LEIE for Compliance
To ensure compliance, healthcare organizations should incorporate regular checks of the OIG LEIE into their standard operating procedures. Here’s how to do it effectively:
Access the LEIE Database: The LEIE is accessible through the OIG's website. You can use the search function to check for individuals or entities by entering their name, NPI, or other identifying details.
Conduct Regular Exclusion Checks: Perform exclusion checks regularly, typically on a monthly basis, to capture any updates to the LEIE. Regular checks help ensure that your organization is aware of any new exclusions as soon as they are published.
Use Automated Exclusion Search Software: Automated exclusion search tools, such as Exclusion Guard, can simplify the process by conducting regular checks against the LEIE and other exclusion lists. These tools provide real-time alerts, detailed reports, and continuous monitoring to ensure that your organization remains compliant.
Document All Searches: Keep detailed records of all exclusion checks, including the dates, names checked, and results. This documentation is crucial for demonstrating compliance during audits or investigations by regulatory authorities.
What to Do If an Exclusion Is Found
If an exclusion is identified, healthcare organizations must take immediate action:
Reconsider Employment or Contract: Consider ceasing any association with the excluded individual or entity, including terminating employment, revoking privileges, or ending any contractual agreements. Consult an attorney first.
Notify Relevant Authorities: Report the exclusion to relevant federal and state authorities, such as the Centers for Medicare & Medicaid Services (CMS) or the OIG.
Repay Any Overpayments: Organizations may need to repay any amounts received from Medicare or other federal programs for services rendered by the excluded party.
Implement Corrective Measures: Review and update your organization’s compliance policies and procedures to prevent future violations. Ensure that all staff understand the importance of exclusion checks and their role in maintaining compliance.
The OIG List of Excluded Individuals/Entities (LEIE) is an essential tool for maintaining compliance with federal healthcare regulations. By regularly checking this list, healthcare organizations can avoid penalties, maintain eligibility for federal programs, and demonstrate a commitment to ethical practices. Integrating exclusion checks into your compliance strategy, especially through automated tools, helps safeguard your organization against the risks associated with employing or contracting with excluded individuals or entities.
Understanding the OIG LEIE and its significance is not just about compliance; it’s about protecting your organization’s integrity and ensuring the highest standards of care for your patients.