The List of Excluded Individuals and Entities (LEIE) is a data base maintained by the Office of the Inspector General (OIG) for the Department of Health and Human Services (HHS). The LEIE file contains healthcare providers who are prohibited from participating and billing federal programs such as Medicare and Medicaid. As of June 2019, there are approximately 72,000 health care providers in the LEIE file. Healthcare providers are required to check this exclusion list monthly to determine if physicians and other staff have been excluded by the federal government, or face Civil Monetary Penalties for hiring or paying excluded individual and entities.
The other list that hospitals and other healthcare providers are required to check is the U.S. General Services Administration (GSA) System of Awards Management (SAM) List of Debarments and Suspensions. Individuals and entities on this list are prohibited from doing business with the federal government. This data base currently contains over 150,000 individual and entity names, and was formerly known as the Excluded Parties List System (EPLS).
Failure to check these lists could result in thousands of dollars in Civil Monetary Penalties (CMP) and a denial of reimbursement for services provided by the healthcare provider.
But - are these lists complete? are they current? Not always.
It can take several months for the legal process to be completed; from investigation, provider education (if applicable), to indictment, conviction, and being added to an exclusion list, many months can go by. Providers who were convicted in January 2019 for healthcare fraud are still not on the LEIE or the SAM lists (this article was written in July 2019).
For example, in February 2019 in Missouri, Pamela Van Drie and her husband, Lorin Van Drie, were found guilty of perpetrating multiple fraud schemes totaling more than $1 million in Medicaid payments, failing to pay payroll taxes, and collecting unemployment benefits they were net eligible to receive. Neither individual can be found in the LEIE file, the GSA SAM suspension and debarment list, nor the Missouri Medicaid exclusion list.
Another case involves Victoria Guerra, a pharmacist who was charged in February 2019 with conspiracy to violate the federal anti-kickback statute which prohibits the payment of kickbacks to induce physicians to write prescriptions for which payment may be made in whole or in part under a federal health care benefit program. Ms. Guerra is not in the LEIE file, the SAM suspension list, nor the Texas Medicaid exclusion list. If convicted, Guerra faces up to five years in federal prison and a possible $25,000 maximum fine. An indictment does not indicate guilt, as Ms. Guerra is innocent until proven guilty, but a hiring pharmacy or hospital may want to know these circumstances prior to making an offer.
How can you be certain you have covered all of your bases?
Beyond checking the LEIE file, the SAM suspension and debarment list, and all state Medicaid exclusions lists, we recommend you execute a complete online google search, or contact us for our proprietary list of recent indictments and convictions.