To protect further against payments being made to those with exclusions, all current providers and providers applying to participate in state health-care programs must screen their employees and contractors monthly to determine whether they are excluded individuals or entities. These screens are a condition of the provider’s enrollment or re-enrollment into state health-care programs.
To determine whether any exclusion exists, providers must search the List of Excluded Individuals/Entities (LEIE) website at www.oig.hhs.gov/fraud/exclusions.asp by the name of the individual or entity. If a name match is identified, providers can verify the match using a Social Security number (SSN) or Employer Identification number (EIN). This verification is available only online. The downloadable version of the database, which may be compared against an existing database, does not contain SSNs or EINs.
Providers must search the LEIE website monthly to capture any exclusions and/or reinstatements that have occurred since the last search. Providers must report immediately to HHS-OIG any exclusion information they discover when searching the LEIE database.
The Code of Federal Regulations, section 1003.102(a)(2), states that civil monetary penalties may be imposed against Medicaid providers and managed care entities (MCEs) who employ or enter into contracts with excluded individuals or entities to provide items or services to Medicaid recipients. In addition, no Medicaid payments can be made for any items or services directed or prescribed by an excluded physician or other authorized person when the individual or entity furnishing the services either knew or should have known of the exclusion. This prohibition applies even when the Medicaid payment itself is made to another provider, practitioner, or supplier that is not excluded.
For more information, call the TMHP Contact Center at 1-800-925-9126.