One of the most important things to understand about exclusion records is where they are located. Between the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE), SAM.gov, and each state Medicaid list, there are many sources you should be checking to prevent the hefty fines associated with doing business with an excluded individual or party.
At the federal level, exclusions can be found on the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) as well as the SAM.gov exclusion database, which contains exclusion records for many industries.
The majority of states also have their own Medicaid exclusion lists. Even if your state does not have its own list, the OIG still recommends monthly checks of all available state and federal datasets.
For each exclusion list (OIG LEIE, SAM.gov, and each state Medicaid list), there are records for excluded individuals and entities. Below, we've compared the number of records for entities vs. individuals across the various exclusion lists. Although the number of excluded entities is much smaller, the fines that can be levied against your organization are just as severe. Be sure to hover over each list for specific data points!
California
Texas
New York
Pennsylvania
New Jersey
Civil monetary penalties are the fines levied against healthcare organizations for doing business with an excluded individual or entity. The OIG allows organizations to self-disclose in exchange for a lesser fine. If the above cases had been enforced to their fullest extent by the OIG, the total fines could have exceeded $64,000,000.
*Not all exclusions reported by the OIG contained a fine amount.
