HHS/OIG Deputy Inspector General Gary Cantrell testified earlier this year that States are failing to report all of the adverse actions taken by their Licensing Boards. He suggested that the “manner and time of the [reported] notices” are unreliable. Cantrell attributed these concerns to the “voluntary” nature of State reporting obligations.^[1]

I.  The Impact on Exclusion Enforcement

Gary Cantrell stressed the importance of the Office of the Inspector General’s (OIG) ability to exclude individuals and entities from participating in federal health care programs as a key administrative tool in fighting fraud. He emphasized that “adverse actions…enable us to identify numerous individuals who are subject to exclusion….” If the OIG, however, is not informed about these individuals in the first instance, or is informed in an untimely way, then it may never become aware that they should be considered for inclusion on the List of Excluded Individuals and Entities (LEIE). This creates a significant risk to the Medicare Trust Fund and thwarts the OIG’s ongoing exclusion enforcement initiative.

Mr. Cantrell stated that the issue arises principally due to the manner in which the information is reported. States report the adverse actions to the OIG on a voluntary basis. It can also be reported from individual State boards, general public notices of State board action, and from the working relationships between OIG exclusion analysts and other agencies. In addition to incomplete reporting, the timing and manner of the notices completely depend on each State’s licensing board. Cantrell recommended that Congress explore requiring more reliable and standardized reporting from State licensing boards to advance OIG’s ability to exclude providers.

II.  OIG’s LEIE and State Exclusion Registries May Differ  

A license revocation or suspension is grounds in of itself for a permissive exclusion. In addition, the facts that support such an action are often grounds for mandatory exclusions. Indeed, as a consequence of the board action and the underlying conduct, the individual or entity is almost certainly going to be included on the specific State Exclusion Registry. This can result, however, in an individual being excluded on a State Registry, but not on the OIG-LEIE!

III.  The Takeaway: Providers Shouldn’t Rely Exclusively on the LEIE

The takeaway for providers is twofold: 1) The LEIE and State Exclusion Registries can, and will, differ from time to time, and 2) In light of this, providers simply cannot rely exclusively on the OIG-LEIE as their sole exclusion screening tool. Providers should screen, at a minimum,^[2] the federal lists (LEIE and SAM), their state exclusion list, and any unique additional lists that may be required by their State. 

Ashley Hudson, Associate Attorney at Liles Parker, LLP and former Chief Operating Officer for Exclusion Screening, LLC, is the author of this article. Contact the exclusion experts at Exclusion Screening, LLC^SM today for a free consultation by calling 1-800-294-0952 or online.

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[1] Testimony of Gary Cantrell, Deputy Inspector Gen. for Investigation Office of the Inspector General U.S Dep’t of Health and Human Servs.; “Medicare Program Integrity: Screening Out Errors, Fraud, Abuse” before the House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations, 9 (June 25, 2014).

[2] The exclusion experts at Exclusion Screening, LLC^SM automatically screen all State Exclusion lists and strongly recommend that this is a “best practice” for all providers. Our other blog posts on this site more fully discuss our reasons for this recommendation.