The Office of Inspector General (OIG) exclusion has a national scope and is important to many institutional healthcare providers because the United States Congress has established a Civil Monetary Penalty for institutions that knowingly hire excluded parties.  Accordingly, the Office of Inspector General (OIG) maintains the List of Excluded Individuals/Entities (LEIE), a database which provides information to the public, healthcare providers, patients and others relating to the parties excluded from participation in the Medicare, Medicaid and all other Federal healthcare programs.

The Office of Inspector General, under this Congressional mandate, established a program to exclude individuals and entities affected by these various legal authorities, contained in Sections 1128 and 1156 of the Social Security Act, maintains a list of all currently excluded parties called the List of Excluded Individuals/Entities.  Basis for exclusion include convictions for program-related fraud, patient abuse, licensing board actions and default on Health Education Assistance Loans.

The effect of an exclusion (not being able to participate) is:

1. No payment will be made by any Federal health care program for any items or services furnished, ordered, or prescribed by an excluded individual or entity.  Federal health care programs include Medicare, Medicaid, and all other plans and programs that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan).
2. No program payment will be made for anything that an excluded person furnishes, orders, or prescribes.  This payment prohibition applies to the excluded person, anyone who employs or contracts with the excluded person, any hospital or other provider where the excluded person provides services, and anyone else.  The exclusion applies regardless of who submits the claims and applies to all administrative management services furnished by the excluded person.
3. There is a limited exception to exclusions for the provision of certain emergency items or services not provided in a hospital emergency room.  See regulations at 42 CFR 1001.1901(c).