OIG Exclusion

A determination by the Office of Inspector General that a provider is excluded from participation in all federal healthcare programs, meaning no federal funds may be used to pay for their services.

The Office of Inspector General maintains the List of Excluded Individuals and Entities, commonly called the OIG exclusion list or LEIE. If your name appears on this list, you are barred from participating in any federal healthcare program. That includes Medicare, Medicaid, CHIP, TRICARE, and the Veterans Health Administration. Exclusions happen for serious offenses: healthcare fraud, patient abuse, felony convictions related to healthcare or controlled substances, default on Health Education Assistance Loans, and program-related crimes. Some exclusions are mandatory (the OIG has no choice) and some are discretionary (the OIG decides based on the circumstances). The practical impact is devastating. You cannot bill any federal program. Any entity that employs you or contracts with you cannot bill federal programs for items or services you provide, order, or prescribe. If a healthcare organization knowingly employs an excluded individual and bills a federal program, both the individual and the organization face civil monetary penalties. Every credentialing application asks whether you have ever been excluded from Medicare, Medicaid, or any federal healthcare program. Every payer checks the OIG exclusion list during credentialing. Most hospitals and healthcare employers also check monthly because they are liable if they employ someone who is excluded. If you are excluded, there is a process to apply for reinstatement, but it is not automatic and it takes time. The minimum exclusion period is typically five years for mandatory exclusions. You must apply to the OIG in writing, and they will review whether the basis for exclusion has been resolved. You can check whether you are on the exclusion list yourself through the OIG's website. It is a free search. If you have any concern at all, check before you apply for credentialing. Better to know upfront than to have a payer discover it during verification.