Our Healthcare Provider Profiles include the exclusions from the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE) database.
Avoid potential Civil Monetary Penalties (CMP) by automated monitoring of HHS-OIG LEIE, GSA-SAM, and all State Exclusion Lists, as well as the FDA Clinical Investigators—Disqualification Proceedings and Debarment Lists.
Per 42 CFR Part §455.436 — Federal database checks, State Medicaid agencies must do all of the following:
(a) Confirm the identity and determine the exclusion status of providers and any person with an ownership or control interest or who is an agent or managing employee of the provider through routine checks of Federal databases.
(b) Check the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award Management (SAM) (formerly the Excluded Parties List System (EPLS)), and any such other databases as the Secretary may prescribe.
(c)(1) Consult appropriate databases to confirm identity upon enrollment and re-enrollment; and
(c)(2) Check the LEIE and SAM (formerly the EPLS) no less frequently than monthly.
It is essential for healthcare organizations to screen new hires and regularly check current employees, as well as individuals and entities they do business with, to avoid potential Civil Monetary Penalties (CMP).
Health Providers DB updates the Healthcare Provider Profiles with the LEIE exclusion list monthly.
About the LEIE
The Office of Inspector General (OIG) can exclude individuals and entities from federally funded healthcare programs for various reasons, including a Medicare or Medicaid fraud conviction. The OIG has the authority under section 1128 of the Social Security Act (Act) and from Medicare and State healthcare programs under section 1156.
The OIG maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE).
Those excluded can receive no payment from Federal healthcare programs for any items or services they furnish, order, or prescribe. This includes those that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan).
Reasons for Exclusions
Mandatory Exclusions
OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses:
- Medicare or Medicaid fraud and other crimes related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs.
- Patient abuse or neglect.
- Felony convictions for other healthcare-related fraud, theft, or financial misconduct.
- Felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.
Permissive Exclusions
OIG has the discretion to exclude individuals and entities on several grounds, including (but not limited to):
- Misdemeanor convictions related to health care fraud other than Medicare or a State health program, fraud in a program (other than a health care program) funded by any Federal, State, or local government agency.
- Misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances; suspension, revocation, or surrender of a license to provide health care for reasons bearing on professional competence, professional performance, or financial integrity.
- Provision of unnecessary or substandard services.
- Submission of false or fraudulent claims to a Federal health care program.
- Engaging in unlawful kickback arrangements.
- Defaulting on health education loan or scholarship obligations.
- Controlling a sanctioned entity as an owner, officer, or managing employee.
Why is there a distinction between Mandatory and Permissive exclusions?
Just because an individual or entity has not been involved in anything requiring the OIG to issue a mandatory exclusion does not mean they haven’t been given a permissive exclusion for something else entirely.
The LEIE Data Collected
The Health Providers DB includes the following details from the LEIE database. Links to the Exclusion data are provided for reference and research.
Website: https://oig.hhs.gov/exclusions/exclusions_list.asp
Exclusion List: https://oig.hhs.gov/exclusions/downloadables/UPDATED.csv
File Format: CSV
Updates: https://oig.hhs.gov/exclusions/files/leie_updated_information.pdf
Data Dictionary
| Field Name |
|---|
| Last Name |
| First Name |
| Middle Name |
| Business Name |
| General |
| Specialty |
| UPIN |
| NPI |
| Dob |
| Address |
| City |
| State |
| Zip Code |
| Exclusion Type |
| Exclusion Date |
| Reinstate Date |
| Waiver Date |
| Waiver State |