March 5, 2012

The OIG Exclusions Database List of Excluded Individuals and Entities (LEIE) is a comprehensive list of individuals and entities prohibited from participating in the Medicare and Medicaid programs.  The list is updated on a regular basis and is an important resource for all providers. 

If your facility doesn’t currently review the LEIE on a regular basis it may be time to consider updating your protocol.   Without quoting statistics, remember that if you employ even one person on the exclusion list you are at risk of sanctions, penalties and restitution to the Medicare and/or Medicaid programs.

The LEIE lists individuals who have been determined “unfit” to provide care to beneficiaries of a government healthcare program (i.e., Medicare, Medicaid).  There are many reasons someone may be disqualified from participation but the key is if your organization receives reimbursement from Medicare and/or Medicaid you MAY NOT EMPLOY ANYONE ON IDENTIFIED ON THE LEIE. 

Governmental agencies are often very transparent; if time and money are invested in a program you can be sure they are focusing on that program.  That said, the OIG has recently released updated information and webcasts to educate providers on the LEIE.  The message is clear: if you are not currently checking the LEIE the OIG may be doing it for you! 

Some “best practices” include:

1. Screen prospective employees and vendors prior to hiring and screen all existing employees and vendors regularly (annually is a good standard).
2. Ask employees to disclose former names, maiden names, etc. and check those against the database.
3. Remember to double check spelling!
4. It is not sufficient to match a first name and last name on the LEIE.  Do the final step of identity verification using the Social Security Number, Employer Identification Number or the E-1-N.
5. If you find a potential match using the Downloadable Data file you must still verify those results by entering verifying information on line (the Privacy Act prohibits the OIG from including social security numbers on the Downloadable Data file).
6. Document your process.  If there is ever an issue going forward you may need to prove that you properly screened everyone. 
7. If you do identify an employee is excluded consider removing them from the schedule and consider whether you should initiate bill holds or disclose the matter to the OIG through the self-disclosure protocol.

Remember, costly mistakes can and often do impact the bottom line.  Don’t be a victim of the system, resources are available to you, use them!  If you should have any questions or need assistance implementing your plan please contact your HealthCap Risk Manager!

For an updated LEIE visit: www.oig.hhs.gov/exclusions_list