How Often Should You Check the OIG Exclusion List?

The OIG exclusion list should be checked before anyone starts work and then every month after that. For any healthcare organization, this makes exclusion screening an ongoing responsibility that continues for as long as someone works with you. Keeping to a monthly schedule takes effort when you rely on manual searches or when staff, contractors, and vendors change. This guide explains where the monthly standard comes from, who to screen, which lists to check, and how Compliancy Group documents each check.

The OIG exclusion list is the federal record of individuals and organizations barred from Medicare, Medicaid, and other federal health care programs.

Its formal name is the List of Excluded Individuals and Entities (LEIE).

• Who maintains it: The Department of Health and Human Services Office of Inspector General (OIG).
• How to access it: A searchable online database or a downloadable data file.
• What exclusion means: Federal programs will not pay for items or services an excluded person furnishes, orders, or prescribes.

Mandatory exclusions follow convictions such as health care fraud or patient abuse and last at least five years. Permissive exclusions give OIG discretion in other cases, such as a revoked license.

The short answer is monthly. Most healthcare organizations screen people before they start work and then rescreen everyone monthly.

This monthly schedule comes from three sources:

• OIG guidance. OIG’s 2013 Special Advisory Bulletin on the Effect of Exclusion notes that because OIG updates the LEIE monthly, checking monthly minimizes potential overpayment and penalty liability.
• State Medicaid rules. Under 42 CFR 455.436, state Medicaid agencies must check the LEIE and SAM monthly, and many states expect the same of providers.
• Medicare Advantage and Part D contracts. Plans must screen before hire and every month after, and they usually require contracted providers to do the same.

Screen every new employee, contractor, temp, and volunteer before their first day, and screen new owners and board members when they are appointed. Record the date, the identifiers you searched, and the result in the person’s file.

Rescreen your full roster each month, including long-tenured staff. Schedule the check for the days after OIG posts its monthly update, so each search includes the newest exclusions.

Run an extra check when:

• An employee is rehired or returns from extended leave
• Someone moves into a role that involves billing, ordering, or referring
• A person’s legal name, National Provider Identifier (NPI), or license status changes
• You onboard a new vendor or a vendor changes ownership

OIG exclusion screening applies to anyone whose work supports items or services billed to a federal health care program, including staff with no clinical duties.

Your screening list should include:

• Employees in every role. Clinical, billing, coding, and front desk staff, plus managers.
• Temporary and contracted workers. Locum tenens providers, travel nurses, temps, and consultants, even if they work with you for only a few weeks.
• Vendors and suppliers. Billing companies, management services organizations, laboratories, and equipment suppliers.
• Owners and board members. Anyone who owns or controls the organization, plus board members.
• Volunteers and students. Unpaid individuals who assist with patient care or use billing systems.

Depending on the programs you bill, you may also need to check two other lists every month.

Many states publish their own Medicaid exclusion or termination lists, such as the New York Medicaid exclusion list. These can include actions under state law that are never reported to OIG, so a person can be excluded from a state program without appearing on the LEIE. Check the list for each state where you operate, and read your state Medicaid provider agreement to see how often it requires you to screen.

The System for Award Management (SAM) lists individuals and organizations suspended or debarred from federal contracts and programs. OIG’s 2013 bulletin says the LEIE is the source for OIG exclusions, so you do not need SAM to find them. State Medicaid agencies must check SAM, and Medicare Advantage and Part D plans require their contracted providers to check it. If either rule applies to you, add SAM to your monthly screening.

Monthly screening follows OIG’s recommendation, though some organizations screen more often because of their size, staffing, or billing volume.

The table compares the two approaches.

Use the table to decide which approach fits your organization. With either approach, you still need a pre-hire check and an extra check whenever a role or record changes.

Federal programs will not pay claims for work done by an excluded person. Payments already received become overpayments, and the amount grows each month.

A missed exclusion can lead to 3 main consequences:

• Repayment of affected claims. Medicare generally requires providers to report and return an identified overpayment within 60 days. 
• False Claims Act liability. Keeping an overpayment past that deadline can lead to a False Claims Act case.
• Civil monetary penalties (CMPs). OIG can impose a penalty for each item or service when an organization knew or should have known a person was excluded. 

Here’s a hypothetical example: a practice hires a billing specialist who passes a pre-hire check, and OIG excludes that person three months later.

• With annual screening, the practice may not find the exclusion for nine more months and must review every claim the specialist worked on during that time.
• With monthly screening, the practice finds the exclusion at its next check, and the review covers about one month of claims.

A monthly screening process works best when it runs on a fixed date, uses reliable identifiers, and records every search.

A small practice with a stable team can manage this without software:

1. Search each name in OIG’s online LEIE tool, or compare the downloadable file against your staff list.
2. Confirm or rule out any match using a Social Security number or employer identification number.
3. Repeat the search for SAM and any state Medicaid lists that apply.
4. Save a dated screenshot or export of each search.

This process takes more time as you add staff, vendors, and lists.

Exclusion screening software runs these searches automatically and stores the results. Look for matches on date of birth and NPI, checks for aliases and name changes, a connection to your HR system, and a record of every match review. Compliancy Group’s exclusion monitoring checks employee and vendor lists weekly against 55 state, federal, and international exclusion lists, including the LEIE and SAM, and our team helps clients verify possible matches.

Healthcare compliance software can help when exclusion screening is one of several compliance tasks you manage. It is most useful in three situations:

• Your roster is growing. If you run exclusion checks by hand, a scheduled and documented process reduces the time each monthly check takes.
• Your records sit in separate tools. When screening, training, policies, and vendor records are kept in different places, compliance software brings each person’s status into one view.
• Compliance is one of several jobs your organization does. Guided workflows and reminders help you keep checks on schedule and respond when a possible match or new requirement comes up.

Most organizations know they need to check the OIG exclusion list. The harder part is keeping checks on schedule for every employee and vendor, with records that show each one took place. When screening sits in a spreadsheet apart from training, policies, and vendor files, it depends on one person remembering to run it.

Compliancy Group brings exclusion screening, policies, training, risk assessments, vendor management, and incident reporting into one connected platform, with compliance advisors available when questions come up. Request a demo to see how monthly screening fits into your compliance program.

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