Health Providers DB includes monthly updated exclusions from the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).
Avoid potential Civil Monetary Penalties (CMP) by automating the monitoring of your employees and vendors against the HHS-OIG LEIE, GSA-SAM, and all State Medicaid Exclusion Lists, as well as the FDA Clinical Investigators—Disqualification Proceedings and FDA Debarment Lists.
Per 42 CFR Part §455.436 — Federal database checks, State Medicaid agencies must comply with the following regulations:
(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 Excluded Parties List System (EPLS) (now the System for Award Management (SAM)), 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 EPLS (now SAM) no less frequently than monthly.
Healthcare organizations must screen new hires and regularly monitor current employees, as well as individuals and entities they do business with, to avoid potential Civil Monetary Penalties.
This includes doctors, nurses, pharmacists, and other professionals interacting with patients and federal healthcare programs like Medicare or Medicaid.
Even if someone isn’t directly providing care, they might still be involved in billing, patient records, or managing payments from federal programs. These roles are critical, and OIG exclusion checks should apply here.
Think of anyone supplying medical equipment, pharmaceuticals, or services to a healthcare organization. Just because someone isn’t a full-time employee doesn’t mean they shouldn’t be checked. They must pass an OIG background check if they provide goods or services involving federal funds.
Volunteers can be involved with patients or sensitive healthcare operations in specific settings. While not always required, screening volunteers can help ensure the organization maintains compliance with federal regulations.
According to the HHS-OIG Enforcement Actions webpage, here are examples of recent Civil Monetary Penalties reported.
January 6, 2025
December 30, 2024
October 23, 2024
October 8, 2024
September 30, 2024
June 5, 2024
March 14, 2024
February 26, 2024
January 8, 2024
Since 2013, over $18 million in civil monetary penalties have been imposed.
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
The LEIE 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 |