The Things You Don’t Know About the OIG Exclusions List

The OIG exclusions list contains information regarding entities and individuals currently exempted or excluded from participating in healthcare programs. It started in 1977 when the federal government of the United States first issued a list of providers who were excluded from receiving federal government payments due to committing violations.

Managed by the Officer of the Inspector General (OIG) at Health and Human Services (HHS), the database for compliance for healthcare organizations is currently known as the List of Excluded Individuals/Entities (LEIE).

How Do You Get On the OIG Exclusion List

An entity or individual may end up on the OIG exclusion list for various reasons. This is the most severe sanction the civil authorities can impose based on a criminal conviction. Hiring an excluded entity or individual results in non-payment for supplies or services rendered to a patient covered under a funded healthcare program since they have disregarded the law and standards for professional conduct.

The Two Main Types of Exclusions

1. Mandatory

The mandatory exclusions are enforced by law. They require the OIG to exclude entities and individuals for a minimum of 5 years upon being convicted of a felony offense such as fraud related to a state’s healthcare program, patient negligence or abuse, or unlawful manufacture of controlled substances. The second criminal offense calls for 10 years of mandatory exclusion, while the third conviction results in permanent exclusion.

2. Permissive

On the other hand, permissive exclusions give OIG discretion when imposing or deciding on the term of exclusion as the offenses registered are on a misdemeanor level. This is largely reported as theft, embezzlement, misconduct, breach of responsibility, or fraud relating to any healthcare item or service.

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