Office of Inspector General - OIG Exclusion Program
Department of Health and Human Services (HHS)

The goal of this exclusion program is to prevent certain individuals and businesses from participating in Federally-funded health care programs. The Office of the Inspector General (OIG), under a 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, and maintains a list of all currently excluded parties called the List of Excluded Individuals/Entities (LEIE).

The basis for exclusions includes convictions for program-related fraud and patient abuse, licensing board actions and default on Health Education Assistance Loans.

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

• 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.
• 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 and management services furnished by the excluded person.

An OIG exclusion has national scope and is important to many institutional health care providers because the Congress of the United States established a Civil Monetary Penalty for institutions that hire excluded parties. Accordingly, the OIG maintains a database which provides information to the public, health care providers, patients and others relating to parties excluded from participation in the Medicare, Medicaid and all Federal health care programs. Individuals and entities who have been reinstated are removed from the LEIE.

The LEIE contains only exclusion actions taken by the OIG. There are many bases for an exclusion, including a conviction related to the Medicare or Medicaid program, a conviction related to patient abuse, or an action taken by a State licensing authority. The LEIE only reports exclusion actions taken by the OIG as a result of those other actions. The LEIE is not a clearinghouse for reporting actions taken by other agencies.

ISTmedWatch ships with the latest version of the LEIE list and offers batch and interactive search capabilities. The data is automatically updated without manual intervention ensuring that customers are always current. ISTmedWatch is designed to automate the OIG screening process and to keep record of the processed records for audit and compliance purposes. In addition to LEIE, ISTmedWatch can search against GSA EPLS, CMS opt out, OFAC SDN and other custom user supplied lists.

The main advantages of ISTmedWatch are:

• Easy to use, automated processing
• Automatic data format processing and updates with no manual intervention
• Extensive reporting, auditing and transaction logging
• Advanced, fuzzy searching and matching engine ensuring even inexact matches are found