State Exclusions or Terminated Providers

According to Performance Standard 8, state MFCUs have a time slot of 30 days to report exclusions to HHS Office of Inspector General (OIG). Many states fail to fully report all exclusions to the OIG, leaving gaps in reporting, which results in a limited exclusion data set for the OIG List of Excluded Individuals and Entities (LEIE). 

Organizations that only check the OIG LEIE for exclusions are missing the state issued exclusions that have not found their way to the federal list quite yet.

The individuals overlooked during this insufficient process are potentially stacking up fines for organizations if they are hired and billing Medicare and/or Medicaid.