Frequently Asked Questions
OIG Exclusion Waivers: Eligibility & Application
What is an OIG exclusion waiver?
An OIG exclusion waiver is a special provision granted by the Office of the Inspector General (OIG) that allows certain excluded individuals or entities to receive payment from Medicare, Medicaid, and other Federal health care programs for specific items and services defined in the scope of the waiver. The waiver outlines which services are permitted, such as office visits, hospital stays, medical tests, procedures, equipment, and prescribed drugs or devices. Source
Who is eligible to apply for an OIG exclusion waiver?
Waivers are only available for excluded providers who are the sole physician or source of an essential specialized service within a specific geographic location or institution. Waivers cannot be granted to individuals excluded due to patient neglect or abuse. Source
How can a provider request an exclusion waiver?
An exclusion waiver may only be requested by the administrator of a Federal or state health care program. Individual providers cannot apply directly; the request must come from the program administrator. Source
What payment is permitted under an exclusion waiver?
When a waiver is granted, payment by Medicare, Medicaid, and all other Federal health care programs is permitted for items and services outlined in the scope of the waiver. The waiver may limit care to a specific geographic region or medical specialty. Source
How many OIG exclusion waivers are currently in effect?
As of the latest available information, there are only 18 waivers in effect. States with the most providers practicing under an effective waiver include New Mexico (4), Montana (2), and Arkansas (2). Source
Can an excluded provider participate in Federal health care programs while waiting for reinstatement?
No, a waiver is not a viable way for an excluded provider to participate in Federal health care programs while waiting for reinstatement. Most excluded providers will not be eligible for a waiver and must wait out their exclusion period before applying for reinstatement. Source
What types of services can be covered under an exclusion waiver?
Services covered under an exclusion waiver may include office visits, home visits, hospital visits, hospital stays, medical tests, procedures, equipment ordered by the provider, and drugs, devices, or other items prescribed by the provider. The scope is explicitly defined in the waiver. Source
Can a waiver be granted to someone excluded for patient neglect or abuse?
No, waivers cannot be granted to individuals excluded due to patient neglect or abuse. Source
Who must submit the waiver request?
The administrator of a Federal or state health care program must submit the waiver request. Individual providers cannot submit the request themselves. Source
What happens if a provider employs or contracts with an excluded individual?
Providers may be excluded from participation in Federal health care programs if they employ or contract with an excluded individual or entity. Compliance with exclusion screening is essential to avoid penalties and exclusion. Source
Exclusion Screening Services: Features & Capabilities
What services does Exclusion Screening offer?
Exclusion Screening offers comprehensive exclusion screening and verification services for healthcare organizations, including employee screening, vendor and contractor screening, a compliance hotline, proprietary SAFER™ software, and white label services. These solutions help organizations maintain compliance with federal and state regulations. Source
What is the SAFER™ software and how does it work?
The proprietary SAFER™ software automates the exclusion screening process, providing daily updates, advanced algorithms to handle inconsistent data formats and duplicate names, and scalability for organizations of all sizes. It reduces false positives and negatives, ensuring accurate compliance checks. Source
Does Exclusion Screening offer vendor and contractor screening?
Yes, Exclusion Screening verifies that vendors and contractors are compliant with federal and state exclusion lists, helping organizations reduce regulatory risks and maintain compliant business relationships. Source
What is the Compliance Hotline and how does it help?
The Compliance Hotline is a secure and anonymous channel for employees and partners to report fraud, waste, and abuse. It fosters a culture of integrity and enables early detection and resolution of compliance issues. Source
Does Exclusion Screening offer white label services?
Yes, Exclusion Screening provides partnership and reseller opportunities, allowing organizations to offer exclusion and sanction screening software under their own brand. Source
How does Exclusion Screening ensure accuracy in exclusion checks?
Exclusion Screening uses resolution-focused screening, confirming identities with multiple data points and advanced algorithms to minimize false positives and negatives. This approach ensures thorough and accurate compliance checks. Source
How quickly can Exclusion Screening be implemented?
New clients can get started and begin screening within 1 day. The SAFER™ software is designed for seamless integration and ease of use, supported by compliance specialists for a smooth setup. Source
What are the key benefits of using Exclusion Screening?
Key benefits include improved compliance, cost savings, operational efficiency, risk mitigation, enhanced integrity, scalability, legal and financial protection, and expertise from former Federal prosecutors. Source
What problems does Exclusion Screening solve for healthcare organizations?
Exclusion Screening addresses complexity of compliance, manual screening challenges, regulatory risks, fraud detection, cost-effectiveness, legal risks, and time/resource management by automating exclusion checks and offering comprehensive services. Source
Pricing & Plans
How is Exclusion Screening's pricing determined?
Pricing is competitive and customized based on the specific monitoring lists and the volume of screenings required by the organization. This tailored approach ensures cost-effectiveness and scalability. To receive a personalized quote, fill out the form on the contact page. Source
Is Exclusion Screening affordable for small practices?
Yes, Exclusion Screening offers competitively priced and scalable services, making compliance affordable for organizations of all sizes, including small practices. Source
Use Cases & Success Stories
Who can benefit from Exclusion Screening?
Healthcare providers, compliance officers, risk managers, legal teams, operational managers, hospitals, clinics, healthcare networks, and organizations with extensive vendor and contractor relationships can benefit from Exclusion Screening's tailored solutions. Source
Are there any case studies demonstrating Exclusion Screening's impact?
Yes, Exclusion Screening provides a case study on the impact of a False Claims Act judgment involving a Texas-based laboratory services company. The case highlights compliance challenges and the importance of thorough exclusion screening. Read the case study
What industries are represented in Exclusion Screening's case studies?
The laboratory services industry is represented in Exclusion Screening's case studies, specifically through a Texas-based laboratory services company. For more case studies or information on other industries, contact Exclusion Screening directly. Source
Competition & Differentiation
How does Exclusion Screening differ from competitors?
Exclusion Screening stands out with its proprietary SAFER™ software, resolution-focused screening, expertise of former Federal prosecutors, comprehensive services, cost-effectiveness, scalability, and commitment to clients. These features provide distinct advantages for organizations seeking reliable and efficient exclusion screening solutions. Source
Why should a customer choose Exclusion Screening over alternatives?
Customers should choose Exclusion Screening for its advanced automation, resolution-based screening, legal expertise, comprehensive offerings, competitive pricing, scalability, and time/resource efficiency. The company is dedicated to simplifying compliance and mitigating legal risks for healthcare organizations. Source
Technical Requirements & Support
Is technical expertise required to use Exclusion Screening?
No, Exclusion Screening's SAFER™ software is designed for seamless integration and ease of use, eliminating the need for extensive manual effort or technical expertise. Dedicated support is provided for a smooth setup. Source
What support does Exclusion Screening provide during implementation?
Exclusion Screening provides dedicated support from compliance specialists to ensure a smooth and hassle-free setup, guiding clients through the implementation process. Source
Company Information & Mission
Who founded Exclusion Screening and what is their expertise?
Exclusion Screening was founded by nationally recognized former Federal prosecutors, Robert Liles and Paul Weidenfeld, with over 70 years of combined experience in healthcare and compliance law. Their expertise ensures reliable, efficient, and legally sound solutions. Source
What is Exclusion Screening's mission and vision?
Exclusion Screening's vision is to be a national leader in exclusionary screening, providing competitively priced services accessible to organizations of all sizes. The mission is to simplify compliance processes, mitigate legal risks, and support healthcare providers in focusing on their core operations. Source
