The Legal Guide to OIG Exclusions
This article is an updated version of “A Provider’s Guide to OIG Exclusions: Federal Exclusion Regulations and Enforcement Authorities,…
Category Exclusion Screening
Exclusion screening is the federal and state compliance obligation to verify that healthcare employees, vendors, and contractors are not barred from participating in Medicare, Medicaid, or other federally-funded programs. Every healthcare provider that bills a federal program is required to screen upon hire and monthly thereafter against the OIG LEIE, GSA/SAM, and all 44 state Medicaid exclusion lists. Failure to screen exposes providers to civil money penalties of up to $24,947 per violation, overpayment liability, and potential False Claims Act exposure. This section of the site is the definitive hub for exclusion screening compliance: the pillar guides, state-by-state requirements, enforcement trends, and the regulatory framework explained by the former federal prosecutors who built it.
Read MoreThe Legal Guide to OIG Exclusions
What is an OIG Exclusion?
OIG Exclusions are powerful enforcement sanctions that bar an individual or entity from any participation in Federal and…
Why Should We Screen Against the Social Security Administration Death Master File?
At Exclusion Screening, we often receive questions about the scope and frequency of an organization’s screening duties and…
Resolving Exclusion Violations through the OIG Self-Disclosure Protocol
I. Introduction The Office of Inspector General (OIG) has the authority to exclude providers from participating in federal…
Medicare / Medicaid Providers Beware: A Nolo Contendere Plea to a Non-Health Care Crime Can Still Result in Exclusion from Medicare
The last two years have been rough for everyone, and it has been particularly difficult for health care…
The Proposed Expansion of CMS’ Revocation Authority Makes Monthly Exclusion Screening of ALL Employees More Important than Ever!
The Centers for Medicare and Medicaid Services (CMS)[1] is the Federal agency tasked with the overall responsibility of…
When an Underlying Misdemeanor or Felony Conviction is Expunged, Does That Extinguish an Exclusion Action?
Medicare and Medicaid providers / suppliers are prohibited from employing individuals who have been excluded from participation in…
North Carolina Exclusion Screening Requirements
North Carolina Division of Health Benefits maintains the North Carolina Medicaid Provider Sanctions List — a separate Medicaid…