Are You Excluded from Participation in Federal Healthcare Programs? How to Check Your Status and What to Do Next

If you face exclusion from Medicare or exclusion from Medicaid, you cannot bill, order, or furnish items or services paid by any federal healthcare program. This guide shows you how to check your status in the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE), interpret results, understand the grounds for exclusion, begin the reinstatement application process, communicate with the OIG, implement healthcare provider screening, and maintain federal healthcare program compliance. This is general information, not legal advice.

Access the List of Excluded Individuals and Entities

What you need before you search

• Full legal name and any former names or aliases (for entities, the legal business name and “doing business as” names).
• Date of birth for individuals; employer identification number (EIN) and, if applicable, National Provider Identifier (NPI).
• Current and prior addresses, professional license numbers, and specialties if relevant.

How to search the LEIE

• Use the Office of Inspector General’s LEIE online search to check by name or NPI, or review the downloadable database if you need to screen large rosters.
• Run multiple variations: include middle names/initials, hyphenations, and common misspellings. For entities, try exact and abbreviated forms.
• Search each individual and entity separately; do not assume a group or corporate search covers all associated professionals.

Tips for accurate results

• Prioritize NPI-based searches when available, then confirm with biographical details.
• Document each query (date, identifiers used, and outcome) so you have an auditable record of your healthcare provider screening.

Review Exclusion Search Results

How to interpret what you see

• Do not treat a name match as a confirmed exclusion. Compare multiple identifiers (DOB, city/state, NPI, license) to validate a true match.
• Review key fields such as the exclusion type, effective date, and, if present, a reinstatement date.
• If the record indicates “reinstated,” the individual or entity is no longer excluded. Keep a copy of the reinstatement notation for your files.

When results are unclear

• For common names or partial matches, gather more identifiers (licensure documents, prior addresses) and re-run targeted searches.
• If uncertainty remains, pause federally billable work for the potentially matched person and seek clarification from the OIG before proceeding.

Understand Grounds for Exclusion

Mandatory exclusions

• Program-related convictions, including fraud or other offenses connected to Medicare, Medicaid, or other federal healthcare programs.
• Felony healthcare fraud or other felony financial offenses tied to healthcare delivery or payment.
• Felony convictions related to controlled substances.
• Patient abuse or neglect.

Permissive exclusions

• Professional license revocation, suspension, or surrender for reasons related to competence, performance, or financial integrity.
• Submission of false or fraudulent claims, kickback-related misconduct, or obstruction of an investigation.
• Quality-of-care deficiencies or other conduct the OIG determines warrants exclusion to protect federal program integrity.

Exclusion bars payment for items or services furnished, ordered, or prescribed by an excluded person or entity, whether billed directly or indirectly through another provider. Violations can trigger civil monetary penalties and repayment obligations.

Initiate the Reinstatement Process

Confirm eligibility and prepare

• Exclusion does not end automatically. Confirm your eligibility date in your exclusion notice or LEIE entry.
• Assemble documentation showing remediation (e.g., court dispositions, compliance training, license reinstatement, monitoring agreements).

Submit your request

• Follow the OIG’s instructions to begin the reinstatement application process. Complete required forms and include supporting evidence that risks have been addressed.
• Ensure information is consistent across all documents (names, identifiers, dates). Inconsistencies can delay review.

Ongoing communication and decision

• Respond promptly to OIG requests for additional information and keep copies of everything you send.
• If approved, you will receive a written Notice of Reinstatement. Keep this letter and verify that the LEIE reflects your reinstatement.
• If denied, review the reasons and reapply after the period stated in the denial notice with stronger documentation.

Communicate with the Office of Inspector General

• Use the case or reference number from your exclusion or reinstatement correspondence on all communications.
• Provide complete, accurate information the first time; partial submissions slow reviews.
• Designate a single point of contact (you or counsel) to avoid mixed messages and missed deadlines.
• Preserve confidentiality: submit sensitive identifiers using the secure methods the OIG specifies.
• Keep a communication log (dates, recipients, topics) to demonstrate diligence and good-faith cooperation.

Implement Regular Exclusion Screening

Build a consistent schedule

• Screen at onboarding and monthly thereafter. Monthly healthcare provider screening is a widely accepted best practice for federal healthcare program compliance.
• Screen all workforce members who provide, order, prescribe, or have a material impact on federally reimbursable services, plus contractors and key vendors.

Operationalize the process

• Standardize identifiers collected at hire (full name, aliases, DOB, NPI/EIN) to improve matching accuracy.
• Maintain auditable logs of every search, match resolution notes, and any corrective actions taken.
• Establish a rapid-response protocol: remove matched individuals from federal program work pending verification, and escalate to compliance and counsel.

Maintain Compliance with Federal Regulations

• Adopt written policies that prohibit employing or contracting with excluded persons in roles that affect federal claims.
• Train managers and credentialing staff on LEIE use, documentation standards, and red flags.
• Integrate screening into credentialing, enrollment, and claims edits to prevent billing for services tied to excluded parties.
• Monitor, audit, and promptly remediate issues; report and refund any identified improper payments as required.
• Retain screening and remediation records consistent with your policy and payer requirements.

Staying off the LEIE—or getting off it through reinstatement—requires clear steps: verify your status, understand the basis for exclusion, complete remediation, apply for reinstatement, maintain open communication with the OIG, and execute disciplined monthly screening. These practices protect patients, preserve reimbursement, and demonstrate a strong culture of compliance.

FAQs.

How can I check if I am excluded from federal healthcare programs?

Search the Office of Inspector General’s List of Excluded Individuals/Entities by name and, if available, NPI. Run multiple name variations, compare identifiers (DOB, city/state, license), and save your results. If you see a potential match but details are unclear, pause federally billable work and seek clarification from the OIG before proceeding.

What offenses lead to exclusion from federal healthcare programs?

Mandatory grounds include program-related convictions, felony healthcare fraud, felony controlled-substance offenses, and patient abuse or neglect. Permissive grounds include licensure actions, certain false-claims or kickback-related conduct, obstruction of investigations, and quality-of-care issues. The OIG evaluates permissive cases to determine if exclusion is warranted to protect program integrity.

How do I apply for reinstatement after exclusion?

Reinstatement is not automatic. After you are eligible, submit a request to the OIG with the required forms and evidence of remediation (e.g., court and licensure documents, compliance measures). Respond promptly to any follow-up requests. If approved, you will receive a Notice of Reinstatement and should verify the LEIE reflects the change.

How often should healthcare entities screen for exclusions?

Best practice is monthly screening, plus checks at onboarding and before assignments that involve federal program reimbursement. Apply the process to employees, contractors, and relevant vendors, keep auditable logs, and act immediately on potential matches to maintain federal healthcare program compliance.