Special Advisory Bulletin From OIG

The Office of Inspector General (OIG) has released an updated special advisory bulletin describing the scope and effect of the legal prohibition on payment by federal health care programs for items or services furnished (1) by an excluded person or (2) at the medical direction or on the prescription of an excluded person. For purposes of Office of Inspector General (OIG) exclusion, payment by a federal health care program includes amounts based on a cost report, fee schedule, prospective payment system, capitated rate, or other payment methodology. Furthermore, it describes how exclusions can be violated and the administrative sanctions OIG can pursue against those who have violated an exclusion. The updated bulletin provides guidance to the health care industry on the scope and frequency of screening employees and contractors to determine whether they are excluded persons. Read the bulletin here.

Also, remember that the OIG’s List of Excluded Individuals/Entities (LEIE) provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other federal health care programs. Individuals and entities who have been reinstated are removed from the LEIE. This list should be checked regularly, as hefty fines and penalties can be assessed if you enter into contracts with excluded persons.

On May 14, 2013, OIG updated its LEIE database. The "Updated LEIE" database file reflects all OIG exclusion and reinstatement actions up to and including those taken in April 2013. This new "Updated LEIE" is a complete database file containing all exclusions currently in effect. Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

The new file is meant to replace the "Updated LEIE" file made available for download last month. The new file is complete and need not be used in conjunction with the monthly exclusion and reinstatement supplements. Alternatively you may wish to download either the March Exclusions or Reinstatements databases only, which are posted as the "Current Monthly Supplements."

All the updated files are posted here.

Finally, it should be noted that the full LEIE database — complete with all the monthly updates — is included in the OIG "Online Searchable Database".