The Office of Inspector General (OIG) is a branch of the U.S. Department of Justice. The Inspector General is appointed by the President and confirmed by the Senate. The mission of the OIG is to investigate suspected violations of criminal and civil laws by employees of the Department of Justice and also assesses Department of Justice Programs. OIG also conducts independent audits, inspections and investigations that advance the missions of the Department of State and the Broadcasting Board of Governors.
OIG provides leadership to:
- Promote integrity, efficiency, effectiveness, and economy
- Prevent and detect waste, fraud, abuse, and mismanagement
- Identify vulnerabilities and recommend constructive solutions
- Offer expert assistance to improve Department and BBG operations
- Communicate timely, useful information that facilitates decision-making and achieves measurable gains
- Keep the Department, BBG, and the Congress fully and currently informed
Hiring or working with an individual or entity on the OIG Denied Parties List violates federal law. A violation was cost up to $10,000 per incident.
OIG List of Excluded Individuals and Entities (LEIE)
OIG’s List of Excluded Individuals and Entities supplies information regarding individuals and entities who are presently excluded from involvement in Medicare, Medicaid and all other Federal healthcare programs. This information is given so that providers who bill Federal health care programs do not submit claims for those on the LEIE. The LEIE is update monthly for the most accurate results.
Being on the list does not exclude an individual’s ability to receive benefits under the Federal health care programs. It only affects the capability to claim payment for services given from these programs. Furthermore, an excluded individual can apply for reinstatement after the terms of their denial have been completed.
The OIG special advisory bulletin states:
“… A provider or entity that receives Federal health care funding may only employ an excluded individual in limited situations. Those situations would include instances where the provider is both able to pay the individual exclusively with private funds or from other non-federal funding sources, and where the services furnished by the excluded individual relate solely to non-federal program patients. In many instances, the practical effort of an OIG exclusion is to preclude employment of an excluded individual in any capacity by a health care provider that receives reimbursement, indirectly or directly, from an Federal health care program.”
The Department of Health and Human Services (HHS)
The Department of Health and Human Services is the government’s major agency for protecting the health of Americans and offering crucial human services. HHS administers the more grant dollars than any other federal agency. Medicare and Medicaid are among the more than 300 programs administered by HHS and provide health care for one in four Americans. HHS is made up of 11 operating divisions across the U.S.
The HHS Excluded Individuals and Entities list is included in the OIG Denied Parties search.
Who Needs to Search the OIG Denied Parties List?
Any company or organization in the medical field that uses federal funds should have their employees screened that they are not on the OIG Denied Parties List.
More specifically, those companies are:
- Hospitals
- Medical Schools
- Nursing Homes
- Medical Supplies
The Process
In order to search the list, Crimcheck will do a preliminary name search. If at this point a potential match is made we will use the individual’s social security number to confirm or deny the identity match.
There can be 2 outcomes:
Clear: No record found; the individual is not on the OIG Denied Parties List
Match: A record was found and a match was made, the individual is on the OIG Denied Parties List
Exclusion Reasons
There are a number of reasons why an individual can appear on the OIG Denied Parties List. Some of the more frequent reasons are:
- Fraud
- Substance Abuse
- Patient Neglect/Abuse
- Licensing Board Disciplinary Actions
- Failure to Pay Student Loans
For a Complete List of all Exclusion Reasons, the Minimum Time Period and their Corresponding Codes, please visit the OIG and HHS website.
Federal Offices of Inspectors General
There are 73 federal offices across the country of inspectors general which employ special agents and auditors that detect and prevent fraud, abuse and mismanagement of government programs. An Inspector General can be appointed by agency heads or by the president and confirmed by the senate.
The Inspector General Reform Act of 2008 (IGRA) amended the original Inspector General Act of 1978 by increasing pay, adjusting powers and created the Council of the Inspectors General on Integrity and Efficiency (CIGIE).
Terms to Know
Medicaid: Federal healthcare program for American individuals and families who have low incomes and resources.
Medicare: Federal healthcare program available to Americans ages 65 and older. It is also available to younger Americas with disabilities.
Public Health Care Coverage: Social insurance programs that provide healthcare to people who must meet certain requirements, like age or income, which is funded by the federal government.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA): Protects health insurance coverage for employees and their families when they change or lose their jobs and also established a national standard for the security and privacy for all health data.
