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OIG Background Check: A Complete Guide

oig check

Healthcare employers should perform OIG background checks to identify applicants and employees who have been excluded from participating in federal healthcare programs, including Medicare and Medicaid.

Failing to conduct an OIG background check on every applicant can result in the loss of your company’s ability to contract with Medicare and Medicaid, expose you to civil penalties, and expose your patients to potential danger.

The professionals at iprospectcheck have extensive experience conducting healthcare sanctions checks for providers across the U.S.

Here’s what you should know about Office of Inspector General (OIG) checks.

What is an OIG Background Check?

The U.S. Department of Health and Human Services (DHHS) Office of the Inspector General (OIG) maintains a regularly updated database of individual and group providers who have been excluded from participating in federal healthcare programs called the List of Excluded Individuals and Entities (LEIE).

An OIG screening involves searching the LEIE database to check whether an applicant or employee has been excluded from participating in state and federal healthcare programs.

Hiring or contracting with an individual or entity that has been excluded can result in the loss of the ability to contract with Medicare and Medicaid and expose an organization to substantial monetary penalties.

In many cases, OIG screening is included as a component of a comprehensive healthcare background check that might include numerous searches of a broad variety of state and federal government information sources.

Mandatory OIG Exclusions

OIG exclusions are classified as mandatory or permissive.

An individual or entity might be placed on the mandatory exclusion list for any of the following reasons:

  • Medicaid fraud
  • Medicare fraud
  • Offenses related to the delivery of services or items under Medicare, Medicaid, or state SCHIP programs
  • Felony convictions for other types of healthcare fraud
  • Felony theft convictions
  • Felony financial misconduct convictions
  • Felony drug convictions for illegally distributing, prescribing, manufacturing, or dispensing controlled substances

An individual or entity can be mandatorily excluded for five years for the first exclusion.

If they have received two mandatory exclusions, they will be included on the list for 10 years.

Finally, if an individual or entity has received three mandatory exclusions, they will be permanently excluded.

Permissive OIG Exclusions

In most cases, a permissive exclusion will be given for a misdemeanor conviction. The OIG can exercise discretion to issue a permissive exclusion.

The following are some of the reasons why an individual or entity might receive a permissive exclusion:

  • Misdemeanor healthcare fraud convictions other than those involving Medicare or Medicaid
  • Fraud involving any state or federal program other than healthcare programs
  • Misdemeanor convictions for illegally dispensing, prescribing, distributing, or manufacturing controlled substances
  • The suspension, revocation, or surrender of the provider’s license for competence, performance, or financial integrity reasons
  • Providing substandard or unnecessary medical services
  • Submitting fraudulent claims to a federal healthcare program
  • Engaging in unlawful kickback schemes
  • Defaulting on health student loans or scholarship obligations
  • Having an ownership interest in or control of a sanctioned entity

Permissive exclusions are listed on the LEIE database at the OIG’s discretion and typically remain for up to three years.

Other Searches Included in a Healthcare Pre-Employment Background Check

An OIG background screening is typically included in a broader search of a variety of information sources.

In addition to healthcare sanctions checks, other types of searches that are typically performed include the following:

Performing a comprehensive background screening of any prospective candidate is critical to protect your patients, other employees, and the organization.

Types of Workers Who Should Undergo Screening

Healthcare employers should screen all of the following types of employees and applicants by checking the LEIE and state sanctions lists:

If you hire anyone who is included in the LEIE, your healthcare company can face the loss of its ability to contract with Medicare and Medicaid and face civil monetary penalties.

State Medicaid Exclusions Lists

To date, 44 states maintain state Medicaid exclusions lists for people in their jurisdictions who have been excluded from participating in Medicaid.

The states must upload this data with the OIG for inclusion in the LEIE.

Since the OIG LEIE is updated monthly, and individual states might have varying schedules for updating their lists and uploading the information to the OIG, there could be a period during which a person is not yet listed on the OIG LEIE.

This makes it important to check all of the following state lists:

• AlabamaList of Suspended Providers
• AlaskaAlaska Excluded Provider List
• ArkansasArkansas Department of Human Services (DHS) Excluded Provider List
• CaliforniaCalifornia Department of Health Care Services (DHCS) Suspended and Ineligible Provider List
• ColoradoColorado Department of Health Care and Policy Financing (HCPF) Terminated Provider List
• ConnecticutConnecticut Department of Social Services (DSS) Quality Assurance Administrative Actions List
• DelawareDelaware Sanctioned Providers List
• FloridaFlorida Attorney General’s Medicaid Fraud Control Unit Medicaid Sanctioned Providers
• GeorgiaGeorgia OIG Exclusions List
• HawaiiHawaii Department of Human Services Provider Exclusion/Reinstatement List
• IdahoIdaho Medicaid Exclusions List
• IllinoisIllinois OIG Provider Sanctions
• IndianaIndiana Family and Social Services Administration (FSSA) Termination of Provider Participation in Medicaid and CHIP
• IowaIowa Medicaid Sanctions List
• KansasKansas Department of Health Care Finance (DHCF) Medicaid Program Integrity Terminated Providers List
• KentuckyKentucky Medicaid Provider Termination and Exclusion list
• LouisianaLouisiana State Adverse Actions List
• MaineMaineCare Excluded Providers Search
• MarylandMaryland Medicaid Administration (MMA) Providers and Other Entities Sanctioned List
• MassachusettsMassHealth List of Suspended or Excluded Providers
• MichiganMichigan Health and Human Services List of Sanctioned Providers
• MinnesotaMinnesota Excluded Group Providers and Minnesota Excluded Individual Providers
• MississippiMississippi Division of Medicaid Sanctioned Provider List
• MissouriMissouri Medicaid Program List of Terminations
• MontanaExcluded or Terminated Montana Medicaid Providers
• NebraskaNebraska Medicaid Excluded Providers
• NevadaNevada Medicaid Sanctions/OIG Exclusions List
• New HampshireNew Hampshire Medicaid Provider Exclusion and Sanction List
• New JerseyNew Jersey Medicaid Fraud Division Provider Exclusions
• New YorkNew York State Office of the Medicaid Inspector General (OMIG) Restricted and Excluded Providers
• North CarolinaNC Medicaid Provider Termination and Exclusion list
• North DakotaND Medicaid Provider Exclusion List
• OhioOhio Medicaid Provider Exclusion and Suspension List
• OregonOregon Health Plan Sanctioned Providers Search and the OHA State Medicaid Fraud Convictions search
• PennsylvaniaPennsylvania MediCheck List (Precluded Providers)
• South CarolinaSouth Carolina Excluded Providers
• TennesseeTennCare Program Integrity Terminated Provider List
• TexasTexas OIG Exclusions Search
• VermontVermont Medicaid Portal Excluded Providers List
• WashingtonWashington State Healthcare Authority Provider Termination and Exclusion List
• Washington, D.C.Washington, D.C. Excluded Parties List
• West VirginiaWV Medicaid Provider Exclusions and Terminations
• WyomingWyoming Medicaid Provider Exclusion List

How to Complete an OIG Background Check

1. Do-It-Yourself

Some providers attempt to complete OIG checks by taking a do-it-yourself approach.

They might search the LEIE database to check up to five providers at a time by searching with their Social Security number (SSN) or their Employer Identification Number (EIN).

They can also download the database, but doing so is cumbersome, and the downloadable version is more difficult to verify because it does not include the providers’ SSNs or EINs.

To be thorough, employers should also check the above-listed sanctions lists for any state in which an applicant has previously lived and worked.

Attempting a DIY approach to OIG sanctions checks is time-consuming and laborious. It is also easy to overlook a candidate’s listing on a state sanctions list when they haven’t yet been uploaded into the federal OIG LEIE.

Trying a DIY approach could result in incomplete, inaccurate information and might result in potential penalties.

2. Partnering With a Reliable Provider

The best method for conducting an OIG sanction check is to partner with an experienced and reliable provider like iprospectcheck.

We can streamline the process of completing healthcare sanctions checks and can also conduct searches of other information databases that might be relevant, including comprehensive searches of federal and state government sources.

Additional searches, including General Service Administration Systems and Award Management (SAM) checks and FACIS checks, can reveal information that might not be available through OIG checks alone, including the reason for the individual’s exclusion, whether the sanction is active or has ended, and the board that took disciplinary action.

At iprospectcheck, we also ensure our background checks are comprehensive, accurate, current, and fully comply with the Fair Credit Reporting Act (FCRA).

When you work with us, we can help you navigate all relevant laws that impact employment background checks.

What Laws Govern OIG Checks?

The Social Security Act includes two sections that govern OIG checks as described below.

Section 1128 of the Social Security Act

Section 1128 of the Social Security Act is codified at 42 U.S.C. § 1320a–7.

Under this law, the Secretary of the Department of Health and Human Services is mandated to exclude individuals and entities meeting the list of mandatory exclusions.

DHHS can also use its discretion to issue permissive exclusions based on the previously listed reasons and others.

This statute also defines the exclusion periods for mandatory exclusions of five or 10 years or permanently and also for permissive exclusions of up to three years.

Section 1156 of the Social Security Act

Section 1156 of the Social Security Act is codified at 42 U.S.C. § 1320c–5 and outlines the obligations of healthcare providers and organizations.

Under this law, healthcare organizations must do the following things:

  • Only provide services that are medically necessary
  • Provide services economically
  • Provide services that meet professionally recognized standards of care
  • Provide services that are supported by evidence of medical necessity and quality as verified by an auditing body

Penalties Under 42 CFR Part 1003

Under 42 CFR Part 1003, healthcare providers can face penalties and consequences when they hire someone or continue to employ a provider that is included on the LEIE.

Employers can face the following penalties:

  • Denial of payment for any services provided in violation of the exclusions list
  • Repayment of any amounts received for services provided in violation of the exclusion laws
  • Civil monetary penalties of $10,000 for each item or service provided by the excluded individual or entity
  • Potential exclusion of the provider that improperly submitted claims of the laws

The penalties can quickly add up. For example, an Ohio company reached a settlement with the OIG this year to pay a $765,000 fine for employing an excluded individual as an intake coordinator.

FAQs

1. How often should employers check the OIG exclusion list?

The OIG exclusion list is updated monthly. Employers should check the list before extending a job offer and again at the time of employment.

Employers should also continue to check the list after an employee has been hired regularly to ensure they have not been excluded.

2. Can I still hire someone if they showed up on the exclusion list?

No, healthcare organizations should not hire someone who appears on the exclusion list.

If you do, your organization could face substantial penalties and potentially lose the ability to contract with federal and state healthcare programs.

3. What is the difference between OIG and GSA?

The Office of Inspector General (OIG) oversees the U.S. Department of Health and Human Services and regularly updates a list of sanctioned individuals and entities that are barred from participating in any federal healthcare program.

The General Services Administration (GSA) maintains the System of Awards Management (SAM) database of individuals and entities that are barred from engaging in federal contracts of any type, including non-healthcare federal contracts.

4. What is the difference between an OIG and LEIE search?

An OIG check and an LEIE search refer to the same thing. Both mean searching the OIG’s list of excluded individuals and entities to check for sanctions and exclusions.

Turn to iprospectcheck for Fast, Compliant OIG Checks

Healthcare employers that contract with Medicare, Medicaid, and other federal and state healthcare programs must comply with numerous laws and regulations and are prohibited from employing or contracting with excluded individuals and entities.

Failing to perform an OIG check could expose your organization to substantial penalties and consequences while also potentially endangering your patients.

At iprospectcheck, we provide legally compliant, comprehensive, and fast OIG checks for healthcare organizations across the U.S.

To learn more about our comprehensive background check and clinical services and to receive a free quote, call us today: (888) 509-1979

DISCLAIMER: The resources provided here are for educational purposes only and do not constitute legal advice. Consult your counsel if you have legal questions related to your specific practices and compliance with applicable laws.

Know Before You Hire

About the Author
Matthew J. Rodgers

Matthew J. Rodgers

Matthew J. Rodgers is a highly accomplished business executive with over 30 years of experience providing strategic vision and leadership to companies ranging from the fortune 500 to iprospectcheck, a company which he co-founded over a decade ago. Matthew is a valued consultant who is dedicated to helping companies create and implement efficient, cost effective and compliant employment screening programs. Matt has been a member of the Professional Background Screeners Association since 2009 . When not focused on iprospectcheck, he can be found spending time with his family, fly fishing, or occasionally running the wild rivers of the American west. A lifetime member of American Whitewater, Matt is passionate about protecting and restoring America’s whitewater rivers.