Articles

The OIG’s Exclusion List – A Simple Check to Prevent Liability

Health Law alert by Lamb McErlane attorneys Vasilios J. Kalogredis, Esq. and Sonal Parekh, Esq.

To avoid severe consequences, every health care employer should ensure to check the Office of Inspector General’s (“OIG”) List of Excluded Individuals/Entities (“LEIE”) before hiring a new employee.

Updated monthly, the LEIE is a list of all currently excluded individuals and entities who are ineligible to participate in federal health care programs because of criminal activity (including Medicare or Medicaid fraud) or serious professional misconduct. The purpose of the LEIE, also known as the OIG Exclusion List, is to ensure that federal health care program beneficiaries have access to high quality providers by preventing any federal funds from flowing to individuals or entities who have demonstrated their disregard for the law and high standards of professional conduct.

Exclusion is the most extreme civil sanction that can be imposed by the OIG. Accordingly, anyone who hires an individual or entity on the OIG Exclusion List may be subject to civil monetary penalties (”CMP”). Failure to check the LEIE may lead to missing updates and inadvertently retaining or hiring an excluded party, which exposes the health care entity to potential breach of contractual claims, CMP, and other administrative actions by state and/or federal authorities. If a health care entity fails to check the LEIE and hires an excluded individual or entity, the consequences may be severe.

To avoid CMP liability and ensure continued contractual compliance, it is imperative that health care entities that receive federal health care program funds routinely check the OIG Exclusion List to ensure that potential new hires and current employees are not on it. It is important to note that the LEIE does not include historical exclusion data. The LEIE is updated monthly, and its current version, along with any updates thereto, can be found here.

The LEIE is one of two primary federal lists that should be checked for exclusion status by all entities that receive federal health care program funds. The other list that must be checked is SAM.gov. We highly recommend checking these lists monthly to help ensure against potentially major issues.

If you have any questions regarding exclusion, compliance, or other health law matters, contact Bill Kalogredis, Esq. or Sonal Parekh, Esq.

Vasilios J. (Bill) Kalogredis, Esq. has been advising physicians, dentists, and other healthcare professionals and their businesses as to contractual, regulatory and transactional matters for 50 years. He is Chairman of Lamb McErlane PC’s Health Law Department. Bill can be reached by email at bkalogredis@lambmcerlane.com or by phone at 610-701-4402.

Sonal Parekh, Esq., is an associate at Lamb McErlane PC who focuses on healthcare transactional matters and a broad range of healthcare regulatory-related issues on behalf of healthcare systems, physicians, dentists, and other healthcare providers, and is a pharmacist by education and training. Sonal can be reached by email at sparekh@lambmcerlane.com or by phone at 610-701-4416.

*This alert is for educational purposes only and is not intended to be legal advice. Should you require legal advice on this topic or have any questions or concerns, please contact Vasilios J. (Bill) Kalogredis, Esq. or Sonal Parekh, Esq.