What Is the OIG LEIE? The List of Excluded Individuals and Entities Explained

Overview of the OIG LEIE

The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services maintains the List of Excluded Individuals and Entities (LEIE). This database identifies people and organizations barred from participating in federal health care programs such as Medicare and Medicaid to safeguard Health Care Program Integrity.

Exclusion means federal program payment is prohibited for items or services furnished, ordered, or prescribed by an excluded party. The reach is broad: clinical care, billing, administrative, and management services tied to federal claims can all trigger nonpayment. The LEIE is a central tool for Exclusion Enforcement and for preventing Medicare Fraud and related abuses.

Providers, suppliers, and health systems use the LEIE to make informed hiring, contracting, and credentialing decisions. Because Medicaid Exclusion follows federal rules and many states maintain parallel lists, screening helps you avoid downstream payment denials and compliance risk across programs.

Mandatory Exclusions Criteria

Certain offenses require the OIG to impose exclusion. These are typically serious violations that directly threaten program funds or patient safety and usually carry a minimum exclusion period.

• Program-related crimes: criminal convictions for defrauding Medicare or Medicaid, theft, embezzlement, or other health care fraud schemes.
• Patient abuse or neglect: offenses against patients in connection with the delivery of health care services.
• Felony health care fraud: felony convictions related to the delivery of health care items or services, including sophisticated billing schemes.
• Felony controlled-substance offenses: unlawful manufacture, distribution, prescription, or dispensing of controlled substances in a health care context.

Mandatory exclusions are typically for at least five years. Reinstatement is not automatic; after the exclusion period, you must apply and demonstrate that you meet OIG criteria for return to program participation.

Permissive Exclusions Criteria

Permissive exclusions are discretionary and allow the OIG to respond proportionally to a range of misconduct. These often arise from conduct that, while serious, may not fall into the mandatory categories.

• Professional License Revocation or suspension: loss or surrender of a license for reasons related to professional competence, performance, or financial integrity.
• Quality-of-care concerns: failure to meet professionally recognized standards that cause, or risk causing, patient harm.
• Civil judgments or settlements: conduct resolved under the False Claims Act, Anti-Kickback Statute, or similar laws, even without a criminal conviction.
• Misdemeanor fraud or obstruction: offenses involving fraud, theft, false statements, or interference with a health care investigation.
• Exclusion or sanctions by another program: actions taken by state Medicaid agencies or other federal programs, or ownership/control by a previously excluded individual.

In permissive cases, OIG may tailor the exclusion period, pursue a Corporate Integrity Agreement, or take other remedies to promote compliance while protecting program beneficiaries and funds.

Implications of Being Listed

Once listed on the LEIE, you cannot be paid—directly or indirectly—by any federal health care program for covered items or services. This extends to services ordered, prescribed, or supervised by you, as well as administrative or management functions tied to federal claims.

• Payment prohibition: claims linked to an excluded party are not payable and are subject to recoupment.
• Employment and contracting limits: organizations risk Civil Monetary Penalties if they employ or contract with an excluded individual in roles connected to federal program items or services.
• Credentialing and network impact: plans, hospitals, and suppliers may deny privileges or terminate participation based on exclusion status.
• Broader legal exposure: conduct that led to exclusion can also implicate the False Claims Act, state fraud statutes, or professional disciplinary actions.

Even roles that do not directly submit claims can create liability if the work contributes to items or services billed to Medicare or Medicaid. Robust role scoping and documentation are essential to avoid inadvertent violations.

Accessing the LEIE

The LEIE is publicly accessible and searchable. You can perform individual lookups or use a downloadable dataset for batch screening. Searches can be run by name or National Provider Identifier (NPI) for greater precision.

• Search smart: try exact and variant spellings, including hyphenations, middle initials, and former names.
• Verify identity: confirm potential matches with secondary identifiers such as NPI, date of birth, and known practice locations before taking action.
• Document results: retain dated screenshots or reports to evidence due diligence and audit readiness.
• Complement checks: many organizations also review state Medicaid Exclusion lists and other sanction databases for comprehensive risk coverage.

When a potential match appears, pause any onboarding or claim activity tied to that person or entity until you complete verification and, if needed, consult compliance or legal counsel.

Regular Screening Practices

Effective screening is both proactive and continuous. Establish a written policy that sets scope, frequency, and documentation standards tailored to your risk profile and payer mix.

• Scope: screen all employees, medical staff, contractors, referral sources, volunteers in sensitive roles, and key vendors/subcontractors.
• Timing: screen pre-hire or pre-contract and then monthly thereafter; re-screen after name changes or credential updates.
• Workflow: define steps for handling “possible matches,” including evidence gathering, escalation, and decision timelines.
• Recordkeeping: maintain logs, match analyses, and corrective actions to demonstrate ongoing Health Care Program Integrity.
• Training: educate managers and credentialing teams on Exclusion Enforcement basics and when to involve compliance.

Automated tools can help, but you remain responsible for accurate matching and timely remediation. Periodic internal audits validate that screening is consistent and effective.

Compliance and Penalties

Employing or contracting with an excluded party in connection with federal health care items or services can trigger Civil Monetary Penalties, assessments, and repayment of claims. Knowingly submitting or causing the submission of such claims may also create liability under the False Claims Act.

When issues arise, prompt corrective action is critical. Steps may include halting related billing, removing the excluded party from federally reimbursable work, quantifying exposure, and considering self-disclosure where appropriate. Strong policies, role-based training, and leadership oversight reduce recurrence and demonstrate good-faith compliance.

Bottom line: consistent LEIE screening, decisive remediation, and clear documentation protect your organization from payment denials, penalties, and reputational harm while supporting program integrity across Medicare and Medicaid.

FAQs

What does it mean to be excluded on the LEIE?

Exclusion bars an individual or entity from participating in federal health care programs. Payment for items or services furnished, ordered, or prescribed by the excluded party is not allowed, and organizations risk penalties if they use excluded parties for federally reimbursable work.

How often should organizations check the LEIE?

Best practice is to screen before hire or contract and then monthly for all relevant workforce members and vendors. More frequent checks may be warranted for higher-risk roles or when new information suggests a status change.

What are the consequences of employing an excluded individual?

Organizations can face Civil Monetary Penalties, repayment of affected claims, potential False Claims Act exposure, and reputational damage. Credentialing or payer participation may also be jeopardized.

Is the LEIE publicly accessible?

Yes. The LEIE is a public database that you can search by name or NPI, and a downloadable file supports bulk screening. Always verify potential matches with secondary identifiers and keep documentation of your searches.