When Congress enacted the Health Insurance Portability and Accountability Act and the Balanced Budget Act of 1997, it expanded the federal government’s authority to combat fraudulent activities in federally financed health care programs.  It is with this authority that the  Department of Health and Human Services Office of Inspector General (OIG) developed and maintains the List of Excluded Individuals & Entities (LEIE).

The OIG Compliance Guidelines for  health care providers and health care entities dictates that they examine the OIG List of Excluded Individuals/Entities prior to hiring or contracting with individuals or entities.

CI’s OIG EXCLUSION LIST inquiry identifies individuals and entities excluded from participation in Medicare, Medicaid and other federally financed health care programs.  Subjects are examined by name and results found include specialty, exclusion type and date of exclusion.

The effect of an OIG exclusion from participating in federally financed health care programs is that no federal  health care program payment may be made for any items or services: (1) furnished by an excluded individual or entity, or (2) directed or prescribed by an excluded physician.  The prohibition also extends to payment for administrative and management services not directly related to patient care, but that are a necessary component of providing items and services to federally financed health care program beneficiaries.

The practical effect of an OIG exclusion is to preclude employment of an excluded individual in any capacity by a health care provider that receives reimbursement, directly or indirectly, from any federally financed health care program.

CI's General Services Administration Exclusion (GSA) inquiry instantly disseminates information on Individuals that may be excluded from such contracts and/or benefits for various violations including:

• Fraud, antitrust violations, embezzlement, theft, forgery, bribery, false statements, or other offenses indicating                                                                       a lack of business integrity

• Conviction(s) or ongoing investigation(s) for a Federal or State offense relating to the distribution or possession of controlled substances

• Sanctions pursuant to the Foreign Narcotics Kingpin Sanctions Regulations

• Crimes relating to immigration

• Sanctions pursuant to the Terrorism Sanctions Regulations

• Sanctions pursuant to the Foreign Assets Control Regulations, which include:

• Engaging in business with companies located in, controlled by, or organized in the nations of Cuba or Sudan;

• The arrangement of illegal imports from North Korea or Burma;

• Imports/Exports to/from Iraq;

• Imports of “rough diamonds” from Liberia;

• Imports of uncertified diamonds or the receipt of donations in the form of gifts or charitable contributions from Syria or North Korea;

• Transactions with designated international narcotics traffickers, terrorists or foreign terrorist organizations or any persons deemed threatening to the stabilization efforts in the Balkans or Zimbabwe.

• Debarment by the Comptroller General for violation of the Davis-Bacon Act, a law requiring contractors to pay no less than the prevailing wage for federal contracts exceeding in value $2000.

• Failure to fulfil the obligations under any bond; failure to disclose all bond obligations, misrepresentation of the value of available assets or outstanding liabilities; false or misleading statement, signature or representation on a bond or affidavit of individual suretyship or any other serious dishonesty related to bond ownership or suretyship.

• Declared ineligible by the Secretary of Education in accordance with the Higher Education Act and/or the Drug-Free Schools and Communities Act based upon a failure to submit a certification of adoption and implementation of a drug prevention program.

• A Contractor's or Subcontractor's failure to satisfy its obligations under the Equal Opportunity Clause or Affirmative Action Clause of a Federal contract or federally assisted construction contract.