CINXE.COM

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" lang="en"> <head><script type="text/javascript" src="/_static/js/bundle-playback.js?v=HxkREWBo" charset="utf-8"></script> <script type="text/javascript" src="/_static/js/wombat.js?v=txqj7nKC" charset="utf-8"></script> <script>window.RufflePlayer=window.RufflePlayer||{};window.RufflePlayer.config={"autoplay":"on","unmuteOverlay":"hidden"};</script> <script type="text/javascript" src="/_static/js/ruffle/ruffle.js"></script> <script type="text/javascript"> __wm.init("https://web.archive.org/web"); __wm.wombat("https://oig.hhs.gov/faqs/exclusions-faq.asp","20130508143510","https://web.archive.org/","web","/_static/", "1368023710"); </script> <link rel="stylesheet" type="text/css" href="/_static/css/banner-styles.css?v=S1zqJCYt" /> <link rel="stylesheet" type="text/css" href="/_static/css/iconochive.css?v=3PDvdIFv" />  <meta name="google-site-verification" content="tpATPqNEN3HXiSbtqevBE9NdgbuCiN9Vmr6EP94lx6w"/> <meta name="keywords" content="Contact Us"/> <meta name="description" content="Contact Us"/> <title>Exclusions FAQ | FAQs | Office of Inspector General | U.S. Department of Health and Human Services</title> <meta name="author" content="Office of Inspector General, Department of Health and Human Services"/> <meta http-equiv="Content-Type" content="text/html; charset=utf-8"/> <meta http-equiv="X-UA-Compatible" content="IE=EmulateIE7"/>  <link rel="shortcut icon" href="/web/20130508143510im_/https://oig.hhs.gov/images/favicon.ico" type="image/x-icon"/>  <script type="text/javascript" src="/web/20130508143510js_/https://oig.hhs.gov/layout/js/jquery-1.7.2.min.js"></script> <script type="text/javascript" src="/web/20130508143510js_/https://oig.hhs.gov/layout/js/jquery-ui.min.js"></script>   <script type="text/javascript" src="/web/20130508143510js_/https://oig.hhs.gov/layout/js/jquery.smooth-scroll.js"></script>  <script type="text/javascript" src="/web/20130508143510js_/https://oig.hhs.gov/layout/js/fancybox/jquery.mousewheel-3.0.4.pack.js"></script> <script type="text/javascript" src="/web/20130508143510js_/https://oig.hhs.gov/layout/js/fancybox/jquery.fancybox-1.3.4.pack.js"></script> <link rel="stylesheet" type="text/css" href="/web/20130508143510cs_/https://oig.hhs.gov/layout/js/fancybox/jquery.fancybox-1.3.4.css" media="screen"/>  <script type="text/javascript" src="/web/20130508143510js_/https://oig.hhs.gov/layout/js/tooltip/jquery.qtip.js"></script> <script type="text/javascript" src="/web/20130508143510js_/https://oig.hhs.gov/layout/js/waypoints.js"></script> <link rel="stylesheet" type="text/css" href="/web/20130508143510cs_/https://oig.hhs.gov/layout/js/tooltip/jquery.qtip.css" media="screen"/> <link rel="stylesheet" href="/web/20130508143510cs_/https://oig.hhs.gov/layout/css/print.css" media="print" type="text/css"/> <link href="/web/20130508143510cs_/https://oig.hhs.gov/layout/css/style.css" rel="stylesheet" media="screen" type="text/css"/>   <script type="text/javascript" src="/web/20130508143510js_/https://oig.hhs.gov/layout/js/superfish.js"></script>   <script type="text/javascript" src="/web/20130508143510js_/https://oig.hhs.gov/layout/js/functions.js"></script> <script> /* Mobile Navigation */ $(document).ready(function() { $('#m-menu').click(function(){ $('#looking-box').slideToggle("slow"); }); }); </script> <style type="text/css"> /* Fancybox mods */ #fancybox-right { right:-30px !important; } #fancybox-left { left:-30px !important; } #fancybox-right:hover span, #fancybox-right span #fancybox-right:hover span, #fancybox-right span { left:auto !important; right:0 !important; } #fancybox-left:hover span, #fancybox-left span #fancybox-left:hover span, #fancybox-left span { right:auto !important; left:0 !important; } /* Changes the width of the arrow links so they don't cover the content of the box */ #fancybox-left, #fancybox-right {width:30px !important;} </style> </head> <body> <div id="bodyContainer"> <div id="textReset"> <a class="skipNav" href="#skipNav"><span>Skip Navigation</span></a> <a class="fontSize" href="#fontSize"><span>Change Font Size</span></a> <div id="header"> <div id="top"></div> <div id="changeFont"> <a name="fontSize"></a> <a class="increaseFont" href="#">+</a> <a class="decreaseFont" href="#">-</a> <a class="resetFont" href="#">Reset</a> </div> <div id="topHeader"> <a href="/web/20130508143510/https://oig.hhs.gov/fraud/report-fraud/index.asp" class="reportFraudButton"><span>Report Fraud Button</span></a> <div id="topNav"> <ul> <li> <a href="/web/20130508143510/https://oig.hhs.gov/">Home</a> </li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/faqs/index.asp">FAQs</a> </li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/foia">FOIA</a> </li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/about-oig/careers/index.asp">Careers</a> </li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/contact-us">Contact</a> </li> <li> <a class="twitter" href="https://web.archive.org/web/20130508143510/http://www.stopmedicarefraud.gov/">HEAT</a> </li> <li> <a class="twitter" href="https://web.archive.org/web/20130508143510/http://get.adobe.com/reader/">Download Reader</a> </li> <li class="item6"> <a class="twitter" href="https://web.archive.org/web/20130508143510/http://twitter.com/OIGatHHS" target="_blank"><span>Twitter</span></a>  </li> <li class="youtube"> <a class="twitter" target="_blank" href="https://web.archive.org/web/20130508143510/http://www.youtube.com/OIGatHHS"><span>YouTube</span></a> </li>  </ul> </div> <div class="clear"></div> </div> <div id="bottomHeader"> <a href="/web/20130508143510/https://oig.hhs.gov/" class="logo"><span>Office of Inspector General U.S. Department of Health and Human Services</span></a> <a class="hhsLogoHeader" target="_blank" href="https://web.archive.org/web/20130508143510/http://www.hhs.gov/"><img src="/web/20130508143510im_/https://oig.hhs.gov/images/hhsLogoHeader1.png" alt="Department of Health and Human Services Logo"/></a> <div id="topSearch"> <form name="oig_search" id="oig_search" method="GET" action="https://web.archive.org/web/20130508143510/http://search.hhs.gov/search" target="_self"> <table style="height: 100%;"> <tr> <td style="width: 190px; padding-left: 9px; vertical-align: middle"> <label for="oigsearchinput">Search the OIG Web Site</label> <input name="submitted" type="hidden" value="submitted"/> <input type="text" name="q" id="oigsearchinput" onfocus="this.value=''" value="Report #, Topic, Keyword.." class="topSearchField" title="Report #, Topic, Keyword.."/> </td> <td> <input name="output" type="hidden" value="xml_no_dtd"/> <input name="sort" type="hidden" value="date:D:L:d1"/> <input name="ie" type="hidden" value="UTF-8"/> <input name="filter" type="hidden" value="0"/> <input name="oe" type="hidden" value="UTF-8"/> <input name="lr" type="hidden" value="lang_en"/> <input name="client" type="hidden" value="oig"/> <input name="ud" type="hidden" value="1"/> <input name="site" type="hidden" value="oig"/> <input name="proxystylesheet" type="hidden" value="oig_test"/> <input name="proxyreload" type="hidden" value="1"/> <input name="submit" id="btnG" name="searchButton" class="topSearchButton" type="submit" value="" target="search_iframe"/> </td> </tr> </table> </form> <a href="/web/20130508143510/https://oig.hhs.gov/search/index-advanced.asp">Advanced</a> </div> </div> <div id="nav"> <ul class="sf-menu"> <li><a href="/web/20130508143510/https://oig.hhs.gov/about-oig/index.asp"><span>About OIG</span></a> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/about-oig/about-us/index.asp">About Us</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/about-oig/about-inspector-general/index.asp">About the Inspector General</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/about-oig/organization-chart/index.asp">Organization Chart</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/about-oig/careers/index.asp">Careers</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/contact-us">Contact Us</a></li> </ul> </li> <li><a href="/web/20130508143510/https://oig.hhs.gov/reports-and-publications/index.asp">Reports & Publications</a> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/reports-and-publications/index.asp">All Reports & Publications</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/reports-and-publications/archives/index.asp">Archives</a></li> </ul> </li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud">Fraud</a> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/child-support-enforcement/">Child Support Enforcement</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/consumer-alerts/index.asp">Consumer Alerts</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/enforcement/index.asp">Enforcement Actions</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp">Medicaid Fraud Control Units - MFCUs</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/fugitives/index.asp">OIG Most Wanted Fugitives</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/report-fraud/index.asp">Report Fraud</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/state-false-claims-act-reviews/index.asp">State False Claims Act Reviews</a></li> </ul> </li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance">Compliance</a> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/accountable-care-organizations/index.asp">Accountable Care Organizations</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/advisory-opinions/index.asp">Advisory Opinions</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/101/index.asp">Compliance 101<br/>and Provider Education</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/compliance-guidance/index.asp">Compliance Guidance</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/corporate-integrity-agreements/index.asp">Corporate Integrity Agreements</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/open-letters/index.asp">Open Letters</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/rat-stats/index.asp">RAT-STATS</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/safe-harbor-regulations/index.asp">Safe Harbor Regulations</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/self-disclosure-info/index.asp">Self-Disclosure Information</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/alerts/index.asp">Special Fraud Alerts, Bulletins, and Other Guidance</a></li> </ul> </li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight">Recovery Act Oversight</a> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#accountability">Accountability Objectives</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#audit">Audit Activities</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#investigative">Investigative Activities</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#evaluation">Evaluation Activities</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#whistleblower">Whistleblower Protection</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#related-links">Related Links</a></li> </ul> </li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/index.asp">Exclusions</a> <ul> <li><a href="https://web.archive.org/web/20130508143510/http://exclusions.oig.hhs.gov/">Online Searchable Database</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/exclusions_list.asp">LEIE Downloadable Databases</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/supplement_archive.asp">Monthly Supplement Archive </a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/tips.asp">Quick Tips</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/waivers.asp">Waivers</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/background.asp">Background Information</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/reinstatement.asp">Applying for Reinstatement</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/contact-us/index.asp#exclusions">Contact the Exclusions Program</a></li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/faqs/exclusions-faq.asp">Frequently Asked Questions</a></li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/exclusions/advisories.asp">Special Advisory Bulletin and Other Guidance</a></li> </ul> </li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom">Newsroom</a> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/whats-new/index.asp">What's New</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/news-releases/index.asp">News Releases</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/new-media/index.asp">New Media</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/spotlight/index.asp">Spotlight Articles</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/testimony-and-speeches/index.asp">Testimony & Speeches</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/outlook/index.asp">OIG Outlook 2013</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/podcasts/index.asp">Podcasts</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/video/index.asp">Video</a></li> </ul> </li> </ul> </div> <div class="clear"></div> </div> <div class="clear"></div>  <div id="m-nav"> <div id="nav-mobile"> <div id="looking-box" style="display:none;"> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/index.asp">Home</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/whats-new/">What's New</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/enforcement/criminal/">Enforcement Actions</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/fugitives/">Most Wanted Fugitives</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/spotlight/">Spotlight Articles</a></li>  <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/">Newsroom</a></li>  </ul> </div> </div> </div>  <a name="skipNav"></a> <div id="mainBody"> <div id="leftSideInterior"> <div id="breadcrumbs"> <ul> <li> <a href="/web/20130508143510/https://oig.hhs.gov/">Home</a> </li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/faqs/index.asp">FAQs</a> </li> <li> Exclusions FAQ </li> </ul> </div> <div id="leftContentInterior"> <h1>Exclusions FAQ</h1> <div class="featuredContent" style="margin: 15px 0;"> <h3>Answers to Questions Concerning Exclusions</h3> </div> <h2 class="acc_trigger"><a href="#"> What is the List of Excluded Individuals/Entities (LEIE)?</a></h2> <div class="acc_container"> <div class="block"> <p>OIG’s List of Excluded Individuals/Entities (LEIE) provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other Federal health care programs. Individuals and entities who have been reinstated are removed from the LEIE. </p> </div> </div>  <h2 class="acc_trigger"><a href="#">What authority does the OIG have to exclude individual or entities? Are there different types of exclusions?</a></h2> <div class="acc_container"> <div class="block"> <p> The OIG imposes exclusions under the authority of sections 1128 and 1156 of the Social Security Act. A list of all exclusions and their statutory authority can be found on the <a href="/web/20130508143510/https://oig.hhs.gov/exclusions/authorities.asp">Exclusion Authorities page</a>.</p> </div> </div>  <h2 class="acc_trigger"><a href="#">What is OIG's Administrative Process for Imposing Exclusions? </a></h2> <div class="acc_container"> <div class="block"> <h3>Summary:</h3> <p> OIG's exclusions process is governed by regulations that implement sections of the Social Security Act. When an individual or entity gets a Notice of Intent to Exclude, it does not necessarily mean that they will be excluded. OIG will carefully consider all material provided by the person who received the Notice as we make our decision. All exclusions implemented by OIG may be appealed to an HHS Administrative Law Judge (ALJ), and any adverse decision may be appealed to the HHS Departmental Appeals Board (DAB). Judicial review in Federal court is also available after a final decision by the DAB.</p> <h3>Details</h3> <p> When OIG is considering excluding an individual or entity under Section 1128 of the Social Security Act (Act), the administrative process is governed by regulations codified at 42 C.F.R. sections 1001.2001 through 1001.2007. The process varies somewhat, depending upon the basis for the proposed exclusion. </p> <p> For all proposed mandatory exclusions (§§1128(a)(1)-(4) of the Act) and most proposed permissive exclusions (§§1128(b)(1)-(b)(5), (b)(8)-(b)(11), (b)(14), and (b)(15) of the Act), the administrative process is the same. OIG sends out a written Notice of Intent to Exclude to any individual that we are considering excluding. The Notice of Intent to Exclude includes the basis for the proposed exclusion and a statement about the potential effect of an exclusion. </p> <p> The Notice of Intent to Exclude is pre-decisional and allows the individual 30 days to respond in writing with any information or evidence relevant to whether the exclusion is warranted and to raise any other related issues, such as mitigating circumstances. OIG considers all available information in making a final decision about whether to impose the exclusion. </p> <p> If we decide to proceed with exclusion, we send the individual or entity a Notice of Exclusion along with information about the effect of the exclusion and appeal rights. The exclusion is effective 20 days after the Notice of Exclusion is mailed, and notice to the public is provided on OIG's website. The exclusion may be appealed to an HHS Administrative Law Judge (ALJ), and any adverse decision may be appealed to the HHS Departmental Appeals Board (DAB). Judicial review is also available after a final decision by the DAB. </p> <p> When a permissive exclusion is being considered under §1128(b)(6) of the Act, the Notice of Intent to Exclude allows the individual or entity to request an opportunity to present oral argument to an OIG official before a decision about whether to exclude is reached. This is in addition to the right to submit documentary evidence and written argument. </p> <p> If OIG decides to proceed with exclusion, we send the individual or entity a Notice of Exclusion and the subsequent administrative process is identical to the one described above. When a permissive exclusion is imposed under §§ 1128(b)(12) or (b)(13) of the Act, OIG is not required to send a Notice of Intent to Exclude. We send the individual or entity a Notice of Exclusion along with information about the effect of the exclusion and appeal rights. The exclusion is effective 20 days after the Notice of Exclusion is mailed, and notice to the public is provided on OIG's website. The subsequent administrative process is identical to the one described above. </p> <p> When OIG is considering excluding an individual or entity under §1128(b)(7) of the Act, the administrative process differs more significantly from the one that is applicable to mandatory exclusions and most permissive exclusions. OIG will send the individual or entity a Notice of Proposal to Exclude. The written notice will include the basis for the proposed exclusion, the length of the exclusion, the factors we considered in setting the exclusion period, the effect of the exclusion, appeal rights and reinstatement information. Based upon this notice, the exclusion will be effective 60 days after the receipt of the notice unless, within that period, the individual or entity files a written request for a hearing. If the individual or entity makes a timely request for a hearing, an exclusion will not go into effect until and unless the ALJ upholds the OIG's decision to exclude. Any adverse decision may be appealed to the DAB, and judicial review is available after a final decision by the DAB. </p> </div> </div>  <h2 class="acc_trigger"><a href="#">What is the scope and effect of an exclusion?</a></h2> <div class="acc_container"> <div class="block"> <p>The scope of an exclusion under Title 11 of the Social Security Act is from Federal health care programs, as defined in 42 CFR 1001.2. Federal health care programs include Medicare, Medicaid, and all other plans and programs that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan). For exclusions implemented before August 4, 1997, the exclusion covers the following Federal health care programs: Medicare, Medicaid, Maternal and Child Health Services Block Grant, Block Grants to States for Social Service, and State Children's Health Insurance programs. Federal health care program exclusions do not reach other federal programs (although HHS or another federal agency could separately initiate a suspension or debarment of an excluded person from other federal procurement or nonprocurement programs). </p> <p>The effect of an exclusion is that no payment will be made by any Federal health care program for any items or services furnished, ordered or prescribed by an excluded individual or entity. No program payment will be made for anything that an excluded person furnishes, orders, or prescribes. This payment prohibition applies to the excluded person, anyone who employs or contracts with the excluded person, any hospital or other provider for which the excluded person provides services, and anyone else. The exclusion applies regardless of who submits the claims and applies to all administrative and management services furnished by the excluded person. </p> <p>There is a limited exception to exclusions for the provision of certain emergency items or services not provided in a hospital emergency room. See 42 CFR 1001.1901(c). </p> <p> Additional information is available in the <a href="/web/20130508143510/https://oig.hhs.gov/exclusions/effects_of_exclusion.asp">Special Advisory Bulletin on the Effect of an Exclusion</a>.</p> </div> </div>  <h2 class="acc_trigger"><a href="#"> Does the LEIE contain exclusions from other agencies? </a></h2> <div class="acc_container"> <div class="block"> <p>No, the List of Excluded Individuals/Entities contains only exclusion actions taken by the OIG</p> </div> </div>  <h2 class="acc_trigger"><a href="#"> When were exclusions first implemented? </a></h2> <div class="acc_container"> <div class="block"> <p>OIG has been implementing exclusions since about 1981, but the Department of Health & Human Services first began imposing them in 1977.</p> </div> </div>  <h2 class="acc_trigger"><a href="#">Does an exclusion affect a person's right to receive benefits under the Medicare, Medicaid and all Federal health care programs? </a></h2> <div class="acc_container"> <div class="block"> <p>No. An exclusion affects only the ability to claim payment from these programs for items or services rendered; it does not affect the ability to receive benefits under the programs. </p> </div> </div>  <h2 class="acc_trigger"><a href="#"> What should I do if I receive a positive match? </a></h2> <div class="acc_container"> <div class="block"> <p> Check the Special Advisory Bulletin on the Effect of an Exclusion for guidance. If you have already employed the individual, check the <a href="/web/20130508143510/https://oig.hhs.gov/compliance/self-disclosure-info/index.asp">Self-Disclosure protocol. </a></p> </div> </div>  <h2 id="waiver" class="acc_trigger"><a href="#">What is a waiver?</a></h2> <div class="acc_container"> <div class="block"> <p>OIG has the authority to waive an individual or entity's exclusion as a provider from Federal health programs. See Section 1128(c)(3)(B) of the Social Security Act (Act) and 42 C.F.R. 1001.1801(b). Waivers are only available for those excluded providers who are the sole community physician or the sole source of essential specialized services in a community. Waivers cannot be granted to those excluded for patient neglect or abuse. <a href="/web/20130508143510/https://oig.hhs.gov/exclusions/authorities.asp">See section 1128(a)(2) of the Act</a>.</p> <p>A waiver may only be requested by <strong>the administrator of a Federal or State health program</strong>. Excluded individuals or entities may not request a waiver from the OIG.</p> <p>A list of <a href="/web/20130508143510/https://oig.hhs.gov/exclusions/waivers.asp">current waivers in effect</a> is available on our website.</p> </div> </div>  <h2 class="acc_trigger"><a href="#">What is the effect of an exclusion waiver on a payment?</a></h2> <div class="acc_container"> <div class="block"> <p>When the OIG grants a waiver to an excluded individual or entity, it permits payment by Medicare, Medicaid, and all other Federal health care programs for items and services that they furnish, order, or prescribe, within the scope of the waiver (e.g., within a specified geographic location or institution, limited to a specific medical specialty, etc.). It is important to note that the waiver means that, within the scope identified in the waiver letter, Federal health care programs will pay for (1) covered services, such as office visits, home visits, and hospital visits, furnished by the physician or other health care provider, (2) hospital stays, medical tests, procedures, and/or equipment ordered by the physician or other health care provider, and (3) drugs, devices, and/or other items prescribed by the health care provider.</p> </div> </div>  <h2 class="acc_trigger"><a href="#"> How does an excluded individual or entity get reinstated?</a></h2> <div class="acc_container"> <div class="block"> <p>Reinstatement of excluded entities and individuals is not automatic once the period of exclusion ends. Those wishing to again participate in the Medicare, Medicaid and all Federal health care programs must apply for reinstatement and receive authorized notice from OIG that reinstatement has been granted.</p> <p> To apply for reinstatement, send a written request to OIG at the address below. We will then provide Statement and Authorization forms that you must complete, have notarized, and return. The information contained in these forms will be evaluated and a written notification of OIG’s final decision on reinstatement will be sent to you. Generally, this process requires up to 120 days to complete, but can take longer. </p> <p> Excluded providers can begin the process of reinstatement within 120 days of the expiration of their exclusion. Premature requests will not be considered. </p> <p> If reinstatement is denied, the excluded party is eligible to reapply after 1 year. </p> <p> To apply for reinstatement, send a written request to: </p> <p> HHS, OIG, OI <br> Exclusions Staff <br> 7175 Security Boulevard, Suite 210<br> Baltimore, MD 21244 </p> <p> Obtaining a provider number from a Medicare contractor, a State agency or a Federal health care program does not reinstate eligibility to participate in those programs. There are no provisions for early or retroactive reinstatement. Additional information in regulations can be found at 42 CFR 1001.3001-3005. </p> </div> </div>  <h2 class="acc_trigger"><a href="#">What is the difference between the LEIE and the General Services Administration's (GSA) Excluded Parties List System (EPLS) and System for Award Management (SAM) websites? </a></h2> <div class="acc_container"> <div class="block"> <p>GSA administers EPLS and SAM, both of which contain debarment actions taken by various federal agencies, including exclusion actions taken by the OIG. The List of Excluded Individuals/Entities contains just the exclusion actions taken by the OIG. You may access the EPLS at: <a class="exit" href="https://web.archive.org/web/20130508143510/http://www.epls.gov/">http://www.epls.gov</a> and SAM at <a class="exit" href="https://web.archive.org/web/20130508143510/https://www.sam.gov/">https://www.sam.gov</a>.</p> </div> </div>  <h2 class="acc_trigger"><a href="#"> How can I report fraud or abuse related to the Medicare and Medicaid programs?</a></h2> <div class="acc_container"> <div class="block"> <p> You may use the contact information on the <a href="/web/20130508143510/https://oig.hhs.gov/fraud/report-fraud"> OIG Hotline page</a>. </p> </div> </div>  <h2 class="acc_trigger"><a href="#"> How do I contact someone about exclusions? </a></h2> <div class="acc_container"> <div class="block"> <p>HHS, OIG, OI <br> Exclusions Staff <br> 7175 Security Boulevard, Suite 210 <br> Baltimore, MD 21244 <br> Phone: (410) 281-3060 <br> Fax: (410) 265-6780 <br> Email: <a href="https://web.archive.org/web/20130508143510/mailto:sanction@oig.hhs.gov"> sanction@oig.hhs.gov</a></p> </div> </div>  <div class="contentSeparator"></div> <div class="featuredContent" style="margin: 15px 0;"> <h3> Answers to Questions Concerning the LEIE</h3> </div> <h2 class="acc_trigger"><a href="#"> What is the data format for the LEIE? </a></h2> <div class="acc_container"> <div class="block"> <p> The List of Excluded Individuals/Entities is available in two formats: </p> <p> The Online Searchable Database enables users to enter the name of an individual or business and determine whether they are currently excluded. If a match is made on an individual, the database can verify with an individual’s Social Security Number (SSN) that the match is unique. Employer Identification Numbers (EINs) are included for excluded entities. </p> <p> The LEIE Downloadable Data File enables users to download the entire LEIE to a personal computer. Supplemental exclusion and reinstatement files are posted monthly to the OIG website, and these files can be merged with your previously downloaded data file to update your list. </p> <p> If you do not wish to rely on the supplements to keep your information updated, download the Downloadable Data File each month. </p> <p> Note: The Downloadable Data File does not contain SSNs or EINs. Therefore, verification of specific individuals or entities through the use of the SSN or EIN must be done via the Online Searchable Database.</a></p> </div> </div>  <h2 class="acc_trigger"><a href="#"> When is the LEIE updated with new information?</a></h2> <div class="acc_container"> <div class="block"> <p> Both versions of the List of Excluded Individuals/Entities are generally updated by the middle of the month. The updates include all actions taken during the prior month. </p> </div> </div>  <h2 class="acc_trigger"><a href="#"> Can you notify me when the LEIE is updated? </a></h2> <div class="acc_container"> <div class="block"> <p> Sign up, located on the bottom right of every page, to receive email notifications when the List of Excluded Individuals/Entities is updated or sign up <a href="/web/20130508143510/https://oig.hhs.gov/rss_feeds.asp">here</a> to receive an RSS feed of updates. </p> </div> </div>  <h2 class="acc_trigger"><a href="#"> Why is there a field to SSNs on the Online Searchable Database, but the SSNs are not available in the Downloadable Data File? </a></h2> <div class="acc_container"> <div class="block"> <p> The Privacy Act prohibits disclosing Social Security numbers (SSN), so they cannot be included in the Downloadable Data File. However, the Online Searchable Database uses the SSN input by the user as one of the matching criteria. It does not supply SSNs to users. If you are a user of the Downloadable Data File - and have a possible match on an individual and want to verify with a SSN - you should use the Online Searchable Database’s SSN feature to verify an identity. </p> </div> </div>  <h2 class="acc_trigger"><a href="#"> What is the most efficient way to search the LEIE? </a></h2> <div class="acc_container"> <div class="block"> <p> If you have only a few names to search, consider using the Online Searchable Database. It allows you to search up to five names at one time and to verify identities using a Social Security number or date of birth. </p> <p> If you have a large group of individuals to search, consider downloading the entire list via the LEIE Downloadable Datafile to your computer and using a spreadsheet or database program to perform searches. </p> <p> Note: The Downloadable Datafile does not contain SSNs or EINs. Therefore, verification of specific individuals or businesses through the use of the SSN or EIN must be done via the Online Searchable Database. </p> </div> </div>  <h2 class="acc_trigger"><a href="#"> What is a UPIN?</a></h2> <div class="acc_container"> <div class="block"> <p> The UPIN (unique physician identification number) was established by the Centers for Medicare & Medicaid Services as a unique provider identifier in lieu of the SSN. UPINs were assigned to physicians as well as certain nonphysician practitioners and medical group practices. </p> </div> </div>  <h2 class="acc_trigger"><a href="#"> What is an NPI? </a></h2> <div class="acc_container"> <div class="block"> <p> The NPI (national provider identifier) has replaced the UPIN (see question above) as the unique number used to identify health care providers. The Centers for Medicaid & Medicare Services first began assigning NPIs in 2006, and providers were required to use it as of mid-2008. </p> </div> </div>  <h2 class="acc_trigger"><a href="#"> How do I obtain information on the DOB, UPIN, NPI, or the SSN if it isn't in the LEIE? </a></h2> <div class="acc_container"> <div class="block"> <p>If a search result does not contain a DOB (date of birth), UPIN (unique physician identification number), NPI (national provider identifier), or SSN (Social Security number), it is not available from the OIG. Contact the <a href="/web/20130508143510/https://oig.hhs.gov/contact-us/index.asp#exclusions">Exclusions Staff</a> to determine if there is any other information available. </p> </div> </div>  <h2 class="acc_trigger"><a href="#"> How can I obtain a copy of an individual's or entity's exclusion notice? </a></h2> <div class="acc_container"> <div class="block"> <p> Submit a written request with a printout from the List of Excluded Individuals/Entities identifying the individual or entity. Requests without the printout will be returned. Generally, the only documentation available is the exclusion notice that informs the subject of the exclusion and its basis, its effect and the subject's appeal rights. If the subject has been reinstated, the notice informing the subject of that action is available. </p> <p> HHS, OIG, OI <br> Exclusions Staff <br> 7175 Security Boulevard, Suite 210 <br> Baltimore, MD 21244 </p> </div> </div>  </div>  </div>  <div id="rightSide"> <div id="imLookingForHeading"><span>I'm Looking For</span></div> <div id="imLookingFor"> <p>Let's start by choosing a topic</p> <div id="chooseTopic"> <a href="#">Select One </a> </div> </div> <div id="topicSelection"> <a href="#" id="closeButton"><span>X</span></a> <ul class="leftSide"> <li> <a href="/web/20130508143510/https://oig.hhs.gov/reports-and-publications/compendium/"> <h3>Compendium</h3> <p>Unimplemented OIG recommendations summarized.</p> </a> </li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/reports-and-publications/workplan/index.asp#current"> <h3>FY 2013 Work Plan</h3> <p>OIG projects planned for 2013.</p> </a> </li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/reports-and-publications/semiannual/index.asp"> <h3>Semiannual Report</h3> <p>Significant OIG activities in 6-month increments.</p> </a> </li> </ul> <ul class="leftSide"> <li> <a href="/web/20130508143510/https://oig.hhs.gov/compliance/101/index.asp"> <h3>Compliance 101</h3> <p>Free educational resources. </p> </a> </li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/compliance/advisory-opinions/index.asp#2011"> <h3>Advisory Opinions</h3> <p>Legal opinions issued by the OIG about the application of its fraud and abuse authorities.</p> </a> </li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/fraud/child-support-enforcement/"> <h3>Child Support Enforcement</h3> <p>OIG plays a role in pursuing deadbeat parents.</p> </a> </li>  </ul> </div> <div class="clear"></div> <div id="subNav"> <ul>  <li><a href="/web/20130508143510/https://oig.hhs.gov/faqs/advisory-opinions-faq.asp">Advisory Opinions FAQ</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/faqs/corporate-integrity-agreements-faq.asp">Corporate Integrity Agreements FAQ</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/faqs/exclusions-faq.asp">Exclusions FAQ</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/faqs/student-diversity-volunteer-internship-program-faq.asp">Student Volunteer Internship Program FAQ</a></li>  </ul> <div class="subNavBottom"></div> </div> <div class="clear"></div> <a href="https://web.archive.org/web/20130508143510/http://exclusions.oig.hhs.gov/" class="buttonExclusions"> <span>Exclusions Database</span> </a> <a href="/web/20130508143510/https://oig.hhs.gov/fraud/report-fraud/index.asp" class="buttonReportFraud"> <span>Report Fraud</span> </a> <div class="clearPadding"></div>  <style type="text/css"> </style> <div id="stay-connected-box" class="stay-connected"> <h2><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/new-media/">Stay Connected</a></h2> <table cellpadding="0" cellspacing="0" border="0" summary="layout table"> <tr valign="top"><td> <ul> <li class="sc-twitter"><a class="twitter" href="https://web.archive.org/web/20130508143510/http://twitter.com/OIGatHHS">Twitter</a></li> <li class="sc-youtube"><a class="twitter" href="https://web.archive.org/web/20130508143510/http://www.youtube.com/OIGatHHS">YouTube</a></li> <li class="sc-widgets"><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/widgets/index.asp">Widgets</a></li> </ul> </td><td> <ul> <li class="sc-podcasts"><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/podcasts/index.asp">Podcasts</a></li> <li class="sc-email"><a href="https://web.archive.org/web/20130508143510/https://public.govdelivery.com/accounts/USHHS/subscriber/new?topic_id=USHHS_236">Email Updates</a></li> <li class="sc-rss"><a href="/web/20130508143510/https://oig.hhs.gov/rss_feeds.asp">RSS Feeds</a></li> </ul> </td></tr></table> </div> <div class="clearPadding"></div> <div id="newsletterSignup"><a name="emailAlerts"></a> <img src="/web/20130508143510im_/https://oig.hhs.gov/images/newsletterSignupEnvelop.png" alt="Newsletter Sign Up Envelop Graphic" class="env"/> <h2><label for="login">Get Email Updates</label></h2> <p class="help"> Stay up to date on the latest OIG news and opinions </p> <div class="newsletterSignup"> <form action="https://web.archive.org/web/20130508143510/https://service.govdelivery.com/service/subscribe.html?code=USHHS_236" method="post"> <table> <tr> <td style="width:228px;"> <input name="code" type="hidden" value="USHHS_236"/> <input name="origin" type="hidden" value="http://www.oig.hhs.gov"/> <input alt="Enter E-mail Address" name="login" onfocus="this.value=''" type="textfield" id="login" class="regular" value="Enter Email Address"/> </td> </tr> <tr> <td> <input at="Submit" type="submit" value="Subscribe" class="buttonSubscribe twitter" name="button"/> </td> </tr> </table> </form> <div class="clear"></div> </div> </div> </div> <div class="clear"></div> </div> </div> </div> <div id="footerContainer"> <div id="footerContent"> <div id="footerNavContainer"> <div id="footerNavAbout"> <h2>About OIG<br/><br/></h2> <ul> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/about-oig/about-us/index.asp">About Us</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/about-oig/about-inspector-general/index.asp">About the Inspector General</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/about-oig/organization-chart/index.asp">Organization Chart</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/about-oig/careers/index.asp">Careers</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/contact-us">Contact Us</a></li> </ul> </ul> </div> <div id="footerNavReports"> <h2>Reports & Publications</h2> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/reports-and-publications/index.asp">All Reports & Publications</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/reports-and-publications/archives/index.asp">Archives</a></li> </ul> </div> <div id="footerNavFraud"> <h2>Fraud<br/><br/></h2> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/child-support-enforcement/">Child Support Enforcement</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/consumer-alerts/index.asp">Consumer Alerts</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/enforcement/index.asp">Enforcement Actions</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp">Medicaid Fraud Control Units - MFCUs</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/fugitives/index.asp">OIG Most Wanted Fugitives</a> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/report-fraud/index.asp">Report Fraud</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/fraud/state-false-claims-act-reviews/index.asp">State False Claims Act Reviews</a></li> </ul> </div> <div id="footerNavCompliance"> <h2>Compliance<br/><br/></h2> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/accountable-care-organizations/index.asp">Accountable Care Organizations</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/advisory-opinions/index.asp">Advisory Opinions</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/101/index.asp">Compliance 101 and Provider Education</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/compliance-guidance/index.asp">Compliance Guidance</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/corporate-integrity-agreements/index.asp">Corporate Integrity Agreements</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/open-letters/index.asp">Open Letters</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/rat-stats/index.asp">RAT-STATS</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/safe-harbor-regulations/index.asp">Safe Harbor Regulations</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/self-disclosure-info/index.asp">Self-Disclosure Information</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/compliance/alerts/index.asp">Special Fraud Alerts, Bulletins, and Other Guidance</a></li> </ul> </div> <div id="footerNavRecovery"> <h2>Recovery Act Oversight</h2> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#accountability">Accountability Objectives</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#audit">Audit Activities</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#investigative">Investigative Activities</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#evaluation">Evaluation Activities</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#whistleblower">Whistleblower Protection</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/recovery-act-oversight/index.asp#related-links">Related Links</a></li> </ul> </div> <div id="footerNavExclusions"> <h2>Exclusions<br/><br/></h2> <ul> <li><a href="https://web.archive.org/web/20130508143510/http://exclusions.oig.hhs.gov/">Online Searchable Database</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/exclusions_list.asp">LEIE Downloadable Databases</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/supplement_archive.asp">Monthly Supplement Archive </a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/waivers.asp">Waivers</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/tips.asp">Quick Tips</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/background.asp">Background Information</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/exclusions/reinstatement.asp">Applying for Reinstatement</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/contact-us/index.asp#exclusions">Contact the Exclusions Program</a></li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/faqs/exclusions-faq.asp">Frequently Asked Questions</a></li> <li> <a href="/web/20130508143510/https://oig.hhs.gov/exclusions/advisories.asp">Special Advisory Bulletin and Other Guidance</a></li> </ul> </div> <div id="footerNavMedia"> <h2>Newsroom<br/><br/></h2> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/whats-new/index.asp">What's New</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/news-releases/index.asp">News Releases</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/new-media/index.asp">New Media</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/spotlight/index.asp">Spotlight Articles</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/testimony-and-speeches/index.asp">Testimony & Speeches</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/outlook/index.asp">OIG Outlook 2013</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/podcasts/index.asp">Podcasts</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/newsroom/video/index.asp">Video</a></li> </ul> </div> <div class="clear"></div> </div> <div id="backToTopContainer"> <a class="backToTop" href="#top"><span>back to top</span></a> </div> </div> </div> <div id="footerBottomContainer"> <div id="footerBottomContent"> <ul> <li><a href="/web/20130508143510/https://oig.hhs.gov/notices/accessibility.asp">Accessibility</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/notices/privacy-notice.asp">Privacy Notice</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/notices/disclaimers.asp">Disclaimers </a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/notices/plain-writing.asp">Plain Writing</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/notices/guidance.asp">Guidance Practices </a></li> <li><a href="https://web.archive.org/web/20130508143510/http://www.npdb-hipdb.hrsa.gov/" target="_blank">HIPDB</a></li> <li><a href="https://web.archive.org/web/20130508143510/http://www.hhs.gov/" target="_blank">HHS.gov</a></li> <li><a href="https://web.archive.org/web/20130508143510/http://www.ignet.gov/" class="ignet" target="_blank">IGnet</a></li> <li><a href="https://web.archive.org/web/20130508143510/http://www.usa.gov/" target="_blank">USA.gov</a></li> <li><a href="/web/20130508143510/https://oig.hhs.gov/sitemap.asp">Site Map</a></li> </ul> <p class="address">Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201 </p> </div> <div id="m-footer"> <ul> <li><a href="https://web.archive.org/web/20130508143510/http://twitter.com/oigathhs">Follow us on Twitter</a></li> <li>|</li> <li><a href="/web/20130508143510/https://oig.hhs.gov/notices/privacy-notice.asp">Privacy</a></li> <li>|</li> <li><a href="/web/20130508143510/https://oig.hhs.gov/notices/disclaimers.asp">Disclaimers</a></li> </ul> </div> </div> </body> </html>