February 7, 2014
The Office of Inspector General (OIG) updated the List of Excluded Individuals and Entities (LEIE) on January 8, 2014. Currently, there are more than 66,000 health care providers excluded from all federal health care programs, such as Medicare, Medicaid and Tricare, according to the LEIE. Providers receiving funding from federal health care plans are required by law to determine if potential and current employees and subcontractors are excluded. Searching the OIG’s LEIE is a necessary task for all healthcare providers.
Searching the LEIE is Important.
The LEIE is a list of all individuals and organizations that are currently excluded by the OIG. Reviewing the LEIE is necessary because health care providers who employ or contract with individuals or organizations on the LEIE may be subject to civil monetary penalties (CMPs). Health care providers or entities may face CMPs if they submit claims to federal health care programs for items or services provided by excluded individuals. Under existing laws, a provider who employs an excluded individual and is reimbursed by federal health care program funds will be required to pay back 100% of the funds received and may be subject to liability under the Civil Monetary Penalties Law.
Individual health care providers must routinely check the LEIE as well to ensure their names are not listed, their employees are not listed and those who they use as subcontractors are not listed.
Significance of Being Excluded from Federal Health Care Programs.
Few health care providers really understand what it means to be excluded from a federal health care program. Exclusion usually occurs as a result of disciplinary action being taken by the state board of medicine, board of nursing, board of psychology, board of pharmacy or other health care licensing entity. If revocation, suspension, restriction or limitation of a license occurs, this is reported to the National Practitioner Data Bank (NPDB). What few know is that if the licensed individual or business entity voluntarily surrenders the license after charges have been filed or an investigation has been opened, this is treated the same as a disciplinary revocation and is reported to the NPDB the same way. This occurs, even if the provider has similar valid licenses in other states.
This will result in action being initiated by the OIG of the U.S. Department of Health and Human Services (HHS), to exclude the individual or business from federal health care programs for a certain number of years. Notice will be mailed to the person or organization who is the subject of the action in a simple letter from the OIG’s Office.
Adverse Consequences of Exclusion by the OIG Include:
What may be even more devastating are the additional collateral consequences that may result from such an exclusion. These include:
- Termination for cause from all state Medicaid Programs.
- Loss of state professional licenses in other states and jurisdictions.
- Loss of hospital, ambulatory surgical center (ASC), and nursing home clinical privileges.
- Removal from the provider panels of health insurers.
- Loss of ability to contract or work for any individual or entity that contracts with the Medicare Program in any capacity (officer agent, shareholder, director, employee or independent contractor, even for non-Medicare products and services such as office supplies, building and construction services, software and systems support, etc.), including physicians, medical groups, hospitals, healthcare systems, ambulatory surgical centers, skilled nursing facilities, health insurance companies, etc.
- Placement on the General Services Administration (GSA) Exclusions List (or “Debarred” List) from all government contracting.
- Loss of ability to contract or work for any individual or entity that contracts with the federal government in any capacity (officer agent, shareholder, director, employee or independent contractor, even for such services as construction projects, janitorial contracts, computer equipment and software services, real estate brokers on federally underwritten housing loans, sales of motor vehicles, products and services to the government, etc.
Fight for Reinstatement.
It is important to fight any action commenced to suspend or terminate your participation in federal health care programs or to exclude you. It is important to attempt to petition to have your exclusion from federal health care programs lifted if this has happened. It is extremely important to have representation by a competent, effective health law attorney with experience in these matters to represent you.
Furthermore, reinstatement is not automatic. Even after a revocation for a period of time is over, the individual still must apply to the OIG for reinstatement.
Have you ever faced exclusion from the federal health care programs? Please leave any thoughtful comments below.