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Understanding Your Practice's Responsibility with OIG Excluded Providers


As healthcare costs continue to increase, the Centers for Medicare & Medicaid Services (CMS) has employed more agencies to conduct investigations to find improper payments through either fraud, waste or abuse. In a semiannual report to Congress released in November 2017, CMS noted that $4.13 billion in investigative recoveries were made. In addition to the monies recouped, 3,244 individuals and entities were banned from participating in federal healthcare programs going forward.

With that high of a return and an anticipated recovery of nearly $3 billion in 20181, CMS wants to continue to look to recoup funds. CMS will report their findings twice a year to Congress.

The Office of the Inspector General (OIG) maintains a list of healthcare providers who are excluded from participating in Medicare, Medicaid and all other federal health care programs. The database includes a variety of healthcare providers, not just physicians.

This list is known as the “List of Excluded Individuals/Entities” (LEIE). A medical practice can face severe penalties for billing and collecting payment from the federal government for patient care performed by an individual on the OIG Exclusion List.

Medical practices should check the OIG Excluded Providers searchable database prior to hiring new healthcare providers to determine if potential hires fall on this list and implement a process for regularly checking the OIG Exclusion List to ensure current employees have not been added to it.

Those excluded individuals or entities could be restored back to the program and their names will be removed from the OIG database.

Practices should also search the database to look at current hires who may work at different facilities or practices.

This information was taken from the InfoDive Coding and Audits webinar held in November 2018.