Federal health care programs such as Medicare, Medicaid, CHAMPUS, VA, etc. are prohibited from issuing payments for goods or services that are directly or indirectly provided by an individual or entity that has been deemed by the Office of Inspector General as “excluded.” This article will explain what it means to be an “excluded” individual or entity and the negative effects a health care practice could suffer if it engages, employs, or consults with an excluded person or organization.
The Office of Inspector General (OIG) (U.S. Department of Health and Human Services) has the authority to exclude individuals and entities from federally funded health care programs pursuant to Sections 1128 and 1156 of the Social Security Act and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals and Entities (LEIE). Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP).
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