OIG Exclusion

The LEIE – What It is Exactly?

The OIG maintains the the List of Excluded Individuals and Entities (LEIE). The list is typically updated during the second week of each month, but is updated monthly without exception.

Exclusion oversight authority for the OIG is based in the Social Security Act §1128. Fines relating to exclusion offenses are codified in 42 U.S. Code § 1003.210. CMPs apply to various infractions, including “a penalty of not more than $10,000 for each separately billable or non-separately billable item or service provided, furnished, ordered, or prescribed by an excluded individual or entity.” The same $10,000 penalty per offense can also apply and accumulate for each day of excluded party employment or affiliation, with other common CMPs as applicable.

Exclusions can be categorized by the offenses committed within two pathways, each carrying their own potential consequences and potential exclusion periods:

Mandatory exclusions:  Mandatory exclusions are similar to determinant sentencing guidelines, resulting from the conviction of crimes such as Medicare fraud, theft, and other felony crimes related to federal and state healthcare programs. Felony offenses related to controlled substances, patient abuse, or neglect will generally result in mandatory exclusion. The minimum exclusion period for mandatory offenses is five years.

Permissive exclusions: On the other hand, permissive exclusions carry discretionary penalties and can arise from a broad range of non-healthcare-related misconduct as well as crimes. The OIG’s exclusion authority may or may not be imposed. In such cases, aggravating and mitigating factors are reviewed on a case-by-case basis during OIG audit and investigation activities. These include the nature and circumstances of the conduct, the individual’s or entity’s cooperation with the investigation, and other corrective measures taken by the individual or entity. The minimum exclusion period for these offenses varies widely and is imposed on a case by case basis, with three years being common.

What Are the Various Ways to Access the LEIE?

  • A publicly searchable online database is available. It includes an effective name search for individuals or entities and a verification function using additional identifiers, such as a person’s Social Security Number (SSN), Employer Identification Numbers (EIN), Date of Birth (DOB), and others if there is a matching.
  • A downloadable file containing the entire LEIE is also available.

It’s possible to check both the online searchable database & the downloadable database as they are updated on a monthly basis.