HealthProviders DB is updated monthly with the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE), so the database is always up to date.
The LEIE exclusions are normalized and matched with the Healthcare Providers’ Profile as Exact or Possible matches, greatly simplifying your research.
Uncover an unparalleled solution to effortlessly and simultaneously search OIG Exclusions, SAM Exclusions, State Exclusion Lists, FDA Debarment, and Clinical Investigators—Disqualification Proceedings—all in one powerful platform!
An excluded individual or entity is prohibited from participating in federal healthcare programs, including Medicare, Medicaid, CHIP, and TRICARE.
Avoid potential Civil Monetary Penalties (CMP) with HealthProviders DB automated exclusion monitoring.
Federal database check regulations
The Federal Database Checks regulations — 42 CFR Part §455.436 mandate that State Medicaid Agencies must:
(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), 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 no less frequently than monthly.
Who needs to be screened?
Healthcare organizations must screen new hires and regularly monitor current employees, as well as the individuals and entities with whom they do business, to avoid potential Civil Monetary Penalties.
This includes doctors, nurses, pharmacists, and other healthcare professionals interacting with patients and federal healthcare programs, such as 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 in patient care or sensitive healthcare operations in specific settings. While not always required, screening volunteers can help ensure the organization maintains compliance with federal regulations.
Resent Civil Monetary Penalties
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
About the LEIE
The Office of Inspector General (OIG) has the authority under Section 1128 and Section 1156 of the Social Security Act (Act) to exclude individuals and entities from federally funded healthcare programs for various reasons, including convictions for Medicare or Medicaid fraud.
Section 1128 covers Medicare, Medicaid, and all other federal healthcare programs that provide benefits funded directly or indirectly by the United States.
Section 1156 extends this scope to include the state-level counterparts of Medicare and the health programs under Section 1128.
Under this authority, the OIG maintains the List of Excluded Individuals/Entities (LEIE), which is updated monthly.
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 the 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
| 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 |