ISTmedWatch© Compliance Suite
(CS)
Healthcare Compliance
OIG - List of Excluded
Individuals/Entities (LEIE):
The
Office of the Inspector General (OIG) maintains a sanction
list or List of Excluded Individuals/Entities (LEIE) that
identifies
those
who have participated or engaged
in certain impermissible, inappropriate, or illegal conduct such
as fraudulent billing, misrepresentation of credentials, etc.
Organizations
employing or contracting with health providers are responsible
to check the
sanction list with each new issuance of
the list,
as they are prohibited from hiring, continuing to employ, or
contracting with individuals named on that list. Organizations
can check
with the
OIG web site at http://www.oig.hhs.gov for
more information.
General Services Administration (GSA) - Excluded Parties Lists
System (EPLS):
The
General Services Administration (GSA) is responsible for maintaining
an index of individuals and entities
that
have been
excluded
throughout the U.S. Government from
receiving Federal contracts or certain subcontracts and from certain
types of Federal financial and non-financial assistance and benefits.
The Excluded Parties List System (EPLS) includes these listings.
For more information please visit http://epls.arnet.gov. Centers for Medicare & Medicaid
Services (CMS)- Opt-Out Providers:
The
Balanced Budget Act (BBA) of 1997 allowed a physician or practitioner
to
opt out of Medicare
and to enter into private contracts with Medicare
beneficiaries if specific requirements are met. When a physician/practitioner "opts
out" of Medicare, no services provided by that individual
will be covered or reimbursed by Medicare. Nor will any reimbursement
be
issued to a Medicare beneficiary for items or services provided
by a physician/practitioner who has opted out of the program.
If a physician/practitioner "opts out" of the Medicare
program, it must be for a two-year period. The only exception
to that rule is
for emergency and urgently needed services where a private contract
had not been entered into with a beneficiary who receives such
services. In addition, the physician/practitioner cannot
choose to opt out of Medicare for some Medicare beneficiaries
but not others;
or for some services but not others.
Lists
of the "Opt-out" providers
are maintained on a regional basis.
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