UPDATE: OIG Advisory on Checking LEIE for Exclusions

In the July 24th CareConnection we published an article on the Health & Human Services Office of Inspector General’s (OIG) Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs, issued May 8, 2013.  This updated Special Advisory Bulletin describes the scope and effect of the legal prohibition on payment by Federal health care programs for items or services furnished (1) by an excluded person or (2) at the medical direction or on the prescription of an excluded person.

The advisory is OIG’s first published guidance on “exclusions” since 1999.   The effect of an OIG exclusion is that no federal health care program (e.g., Medicare or Medicaid) may pay for items or services 1) furnished by an excluded person, or 2) directed or prescribed by an excluded person.  A provider may be liable for up to $10,000 for each item or service furnished, directly or indirectly, by an excluded person, and up to three times the total amount claimed for such items or services.  

OIG recommends searching the OIG-administered List of Excluded Individuals and Entities (“LEIE”) prior to hiring or contracting with an individual or company.  OIG also suggests that providers review LEIE for current contractors and employees on a monthly basis, for any job category or contractual relationship where the item or service being provided is payable by a Federal health care program.  OIG cautions against relying on other databases, such as the GSA’s System for Award Management (“SAM”) or the National Practitioner Database, as a provider’s primary source for exclusion screening.  

The American Health Care Association (AHCA) has provided a step-by-step guide on how to review the databases to search for exclusions.  AHCA intends to put the guide on their website but has provided an advance copy to VHCA members to assist them in reviewing the LEIE database to avoid consequences of fines for hiring or contracting with an excluded entity.