How Often Should You Check the OIG Exclusion List?

culture of safetyThe American healthcare system relies heavily on government-funded programs like Medicare and Medicaid. About 44 million Americans are enrolled in Medicare, and Medicaid provides insurance for around 75 million people (many of them children).

With this in mind, hospitals and other medical offices must make sure that their employees are in good standing with the U.S. Office of Inspector General (OIG). One way to do this is to screen employees against the OIG’s List of Excluded Individuals and Entities (LEIE) at least once a month.

But what is the LEIE, and how can it affect your medical business? Here’s what you need to know.

What is the OIG LEIE List?

The United States’ Office of Inspector General was established in 1976 to assess and prevent incidences of fraud and abuse within the national healthcare programs. This office investigates claims of Medicare and Medicaid fraud — and if there’s evidence of wrongdoing, the individuals involved end up on the LEIE list.

The OIG LEIE list includes healthcare workers from around the country, but 37 states also have their own lists (which you can screen for additional diligence). Individuals who appear on the LEIE list have been found guilty of any number of wrongdoings, including:

  •       Medicare or Medicaid fraud
  •       Patient abuse or neglect
  •       License revocation
  •       Healthcare-related fraud, theft, or other financial misconduct
  •       Unlawful manufacture, distribution, prescription, or dispensing of controlled substances

If a medical professional appears on the LEIE list, his or her services cannot be covered by Medicare, Medicaid, or any other government-funded healthcare program. 

The OIG updates their list daily, and it is possible for individuals to be removed from the list after a certain period of time. Therefore, healthcare facilities must be vigilant in screening their employees to make sure their staff is in compliance with the OIG.

How Often You Should Perform an Exclusion Check

The first time you should perform an exclusion check on an employee is during the hiring process. Medical professionals should not appear on the LEIE at the time of their hiring — and hiring someone on the LEIE can result in significant monetary penalties. Therefore, a LEIE screening should always be part of the hiring process.

Even after you’ve hired a healthcare worker, it is your duty to continually screen your staff against the LEIE. The OIG suggests checking the list at least once a month, as names are constantly being added or removed. Monthly screening can guarantee that your staff is in compliance and that your facility can continue to serve Medicaid, Medicare, and other government healthcare beneficiaries.

Who You Should Screen

It might seem like common sense to screen your physicians, nurses, sonographers, and other healthcare workers in your office. However, the LEIE list is not limited to those individuals who interact with patients. In fact, anyone who works in the healthcare industry, from doctors and nurses to insurance specialists, should be screened by their employer.

In fact, your screening process shouldn’t even end with your employees. Anyone who works in your facility needs to undergo monthly screening from your business! This includes contractors, volunteers, and even members of the board. Anyone who will be working closely with you to assist patients in any way must not appear on the LEIE — and the only way to be sure they don’t is to screen them regularly.

What Happens If You Don’t Verify Workers Against the Exclusions List

If you happen to employ someone on the LEIE list, your facility can suffer from a number of monetary repercussions. Firstly, individuals on the LEIE list cannot have their services covered by Medicaid, Medicare, or any other government healthcare program. This means that your excluded employee or contractor will be unable to work with many of your patients.

Additionally, the OIG can go after facilities that employ excluded individuals for some hefty fines. Some facilities have been fined up to $10,000 PER SERVICE PROVIDED by an excluded medical worker, while others have been removed from all federal medical programs permanently. This makes it impossible to work with any patients enrolled in government healthcare programs, effectively limiting your patient population to unsustainable levels.

How to Manage Exclusion Checks

As you can see, the best way to keep your facility running smoothly is to remain compliant with the OIG — and the best way to do that is to conduct monthly screenings against the LEIE list.

And now, this process is easier than ever thanks to third-party screening vendors, such as ComplianceLine, who will conduct the process for you! We can run monthly screenings against the LEIE list for your entire staff and roster of contractors and volunteers, allowing you the freedom to continue focusing on your patients.

To learn more about OIG compliance screening, contact ComplianceLine today. Our team is here to help you make OIG screenings easy.