OIG Exclusion List
The OIG exclusion list, formally the List of Excluded Individuals/Entities (LEIE), is the HHS Office of Inspector General's database of people and entities barred from participating in federal health care programs. Medicare and Medicaid will not pay for items or services furnished, ordered, or prescribed by an excluded party, so home health agencies must screen employees, contractors, and vendors against the list and act immediately on matches.
Mandatory vs. permissive exclusions
The OIG imposes two kinds of exclusions. Mandatory exclusions follow convictions for Medicare or Medicaid fraud, patient abuse or neglect, felony health care fraud, or felony controlled substance offenses, and carry a minimum five-year term. Permissive exclusions are discretionary and can stem from things like license revocation, misdemeanor fraud, defaulting on health education loans, or kickback involvement. Either way, the effect is the same: no federal health care program payment may be made for items or services the excluded party furnishes, orders, or prescribes.
What exclusion means for a home health agency
The payment prohibition reaches far beyond hands-on care. If an excluded person works for the agency in any role that contributes to federally reimbursed services, including administration, billing, scheduling, or management, the agency risks civil monetary penalties for each item or service and repayment of associated claims. This is why exclusion screening is a core element of any home health compliance program and a standard diligence item in acquisitions. The OIG also expects providers who discover they employed an excluded person to investigate and consider self-disclosure.
Screening best practices
A defensible screening program looks like this:
- Screen every candidate before hire and all staff monthly thereafter, since the LEIE is updated monthly
- Include contract clinicians, therapy staffing companies, billing vendors, and medical directors, not just W-2 employees
- Check state Medicaid exclusion lists and the federal SAM.gov debarment list alongside the LEIE
- Verify potential name matches using date of birth and Social Security number before acting
- Document every search, including negative results, so you can prove screening happened
Common pitfalls
The classic failures are screening only at hire, skipping per-diem staff and contractors, relying on name-only matches without verification, and keeping no record of searches. Agencies operating in multiple states sometimes miss state Medicaid exclusion lists, which are separate from the LEIE and not always synchronized with it. Finally, some agencies never screen referring or certifying practitioners; because payment prohibitions extend to services ordered by excluded practitioners, many compliance programs include them in the monthly sweep.
Frequently asked questions
How often should we check the OIG exclusion list?
The OIG updates the LEIE monthly and recommends monthly screening. Screening at hire plus monthly rechecks of all employees and contractors is the widely accepted standard for home health agencies.
What happens if we discover we employed an excluded person?
Stop the person's involvement in federally reimbursed work immediately, investigate the period of employment, and quantify affected claims. The OIG operates a self-disclosure protocol for these situations, and agencies typically involve healthcare counsel to manage the response and any repayment.
Do we need to screen referring physicians and medical directors?
Medical directors and contracted practitioners should absolutely be screened, since the agency pays them and bills services connected to their work. Many agencies also screen certifying practitioners, because federal programs will not pay for services ordered or certified by an excluded practitioner.