How to Be Removed from the OIG Exclusion List
Federal payments for health care services account for 28% of all health care spending in the United States. Payments from Medicare, Medicaid, TRICARE, and other federal sources are a significant source of funds for nearly every health care organization and provider. The List of Excluded Individuals/Entities is maintained by the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) and dictates which providers are excluded from receiving federal funds.
For providers who are on the LEIE, it is critical to know how to be removed from the list, either through restitution or correcting an error. Here’s how the LEIE works, the step-by-step process to apply for removal, and how to verify that an individual or entity has been properly reinstated.
What leads to an OIG exclusion?
The OIG through the Social Security Act has the power to bar individuals and entities from receiving federal payments as the result of fraud or abuse. There are two types of OIG exclusions: permissive and mandatory.
A permissive exclusion gives the OIG the discretion to exclude individuals and entities based on a number of criteria. Some of these include misdemeanor convictions related to health care fraud or unlawful manufacture, distribution, prescription, or dispensing of controlled substances. Fraud in a federal or state funded program that is not health care related, submission of false claims, or engaging in unlawful kickback arrangements. These and other infractions can land a provider or entity on the OIG exclusion list.
A mandatory exclusion by the OIG is triggered by more serious criminal offenses including Medicare or Medicaid fraud, patient abuse or neglect, felony convictions for certain health care related fraud, theft, or other misconduct. These convictions are associated with mandatory times for exclusion and an excluded individual or entity cannot apply for reinstatement until those time periods have expired.
The OIG Exclusion List Reinstatement Process
The OIG has the authority to reinstate LEIE listed individuals or entities if they meet the necessary requirements.
Once the exclusion criteria have been satisfied or the exclusion period is over, a provider has the opportunity to be reinstated. For those who fall under a mandatory OIG exclusion, the designated exclusion period is listed in their notification letter. The time that an exclusion applies can vary widely depending on the type of exclusion and what criteria have to be met to apply for reinstatement.
However, this reinstatement doesn’t happen automatically. Here are the steps to apply for reinstatement:
- Draft a written request which contains the following:
- Individual’s or entity’s full name (if excluded under a different name, also include that name)
- Date of birth for an individual
- Telephone number
- Email address
- Mailing address
- Fax or email the request to the OIG at (202) 691-2298 or email@example.com.
- If eligible, the OIG will send statement and authorization forms. Fill them out with the proper notarization and return them.
Once the statements and authorization forms have been evaluated by the OIG, they will send a written notice of reinstatement or denial. This is a lengthy process and can take up to 120 days or more.
Continued Monitoring of OIG Exclusions
An OIG exclusion reinstatement is a proactive process. Providers, entities, or the health care organizations that employ them should check the OIG exclusion list frequently to ensure they don’t appear on the LEIE, particularly if there might be an error that led to their exclusion. Once a reinstatement with the OIG is complete, those organizations need to run additional and ongoing monitoring of the OIG exclusion list to maintain compliance and mitigate risk.
Hospitals, health care clinics, and pharmacies should also check state Medicaid exclusion lists to ensure that providers and entities don’t appear on those lists otherwise they run the risk of receiving civil and monetary penalties.
Verisys owned and maintained Fraud Abuse Control Information System (FACIS) contains the most comprehensive data set for screening and monitoring health care providers to ensure compliance and protect against financial and reputational risk for organizations and individual providers. Ongoing monitoring with FACIS gives you insight into provider exclusions and reinstatements to remain compliant.
Having a complete view of a health care provider allows our clients to make better hiring decisions, achieve greater compliance, and also flag potential problems with providers or entities quickly. Our data platform searches for potential matches in thousands of primary source databases and millions of records to ensure that patient safety and provider and organizational reputations are protected.
|Written by Juliette Willard
Healthcare Communications Specialist
Being creative is my passion! Writer. Painter. Problem Solver. Optimist.
Connect with Juliette on LinkedIn