Every nurse should be aware of and regularly check the Office of the Investigative General’s Exclusion List, called the List of Excluded Individuals and Entities (LEIE). Health professionals are placed on this list for fraudulent or abusive acts relating to health care and placement on this list can end a career. (http://oig.hhs.gov/exclusions/index.asp)
The OIG must include any health professional on the LEIE if an individual or entity is convicted of Medicare or Medicaid fraud; patient abuse or neglect; felony convictions for other health-related fraud, theft, or financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.
By discretion, individuals will be placed on the list for a number of reasons, including misdemeanor convictions relating to health care fraud; unlawful use of controlled substances; suspended or revoked licenses; providing unnecessary or substandard services; submitting false claims to a federal health care program; or even defaulting on health education loans.
Placement on this list is detrimental to your career. Effectively, you cannot be employed, in any capacity, even if not related to health care, in a facility that receives any reimbursement from a federal health care program. This means any facility that accepts Medicare or Medicaid cannot hire you in any capacity, unless you are separated from all patients that receive federal healthcare assistance and you are paid from a private fund that specifically excludes any money obtained from repayment from the federal government. When it comes down to it, no employer will hire you.
Placement on this list means also means your private information will be posted to the internet, including your full name, address, and date of birth.
Employers have a duty to check this list prior to hiring a health care professional and the hefty fines being imposed are shaking the health care industry. If a healthcare entity hires someone who is on the list, the employer is subject to fines of $10,000 for “each item or service furnished” by someone while on the exclusion list, such as dispensing medication or providing services to patients.
Reinstatement after the exclusionary period is not automatic, and you must apply for reinstatement, a process which will take 4 months or more.
In the month of July 2011, 106 nursing professionals were placed on this list. Only 11 were reinstated. In June 2011, 154 nursing professionals were placed on the list and only 18 were reinstated.
To appeal, you must submit a written response within 30 days after receiving notice that the OIG is considering exclusion. If a notice of exclusion is issued, then there are multiple levels of appeal in both administrative proceedings and federal court.
Please Note: The statements and information provided on this website are for informational purposes only. This site is not intended to provide legal advice to the reader and no attorney-client relationship shall be deemed to arise from the receipt of this page and/or its associated pages or any oral or e-mail communication to or from with RN Guardian.