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The Health Care Exclusion List

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Physicians, health care businesses, and other medical professionals must comply with a number of federal and state laws and regulations. Failing to comply with even one of these regulations can have serious consequences for the accused, including jail time and fines. What many people do not realize is that health care professionals who are charged with a white collar crime could be placed on the List of Excluded Individuals and Entities (LEIE), which means that he or she will be barred from participating in any federal health care program. To learn more about avoiding these types of devastating results, please contact a member of our white collar crime legal team for a free case evaluation.

Who can be Placed on the Exclusion List? 

The LEIE is administered by the Office of Inspector General (OIG), which is part of the Department of Health and Human Services (HHS). Businesses and individuals who are placed on this list fall under two categories: mandatory exclusion and permissive exclusion. The type of exclusion faced by an individual depends largely on the severity of the offense and whether the individual was convicted. Convictions for Medicaid or Medicare-related crimes, for example, require mandatory exclusion for at least five years. This list also includes the following:

  • Convictions related to the abuse or neglect of patients;
  • A felony conviction for health care fraud; and
  • A felony conviction for selling, using, or manufacturing controlled substances.

Although a criminal act is required for inclusion on the mandatory list, health care professionals can also end up on the LEIE under the permissive exclusion category if they commit one of the following offenses:

  • Submit false claims to a federal health care program;
  • Commit fraud against a non health care-related program that is funded by a government agency;
  • Engage in a kickback scheme;
  • Provide inadequate or unnecessary medical services;
  • Misdemeanor convictions involving the manufacture, distribution, prescription, or dispensing of a controlled substance;
  • Revocation of a medical license due to professional incompetence;
  • Default on a health education loan; or
  • Own or manage an entity that has been sanctioned.

Unlike mandatory exclusions, which are automatic, the OIG has discretion to exclude individuals or entities who are involved in these types of activities.

What are the Consequences of Being Placed on the Exclusion List? 

Medical professionals who are placed on the LEIE are excluded from participating in all federal health care programs. The federal government will also refuse to reimburse an individual or institution for services if they are placed on the list. Even hiring or employing someone on the LEIE can result in substantial fines. Once a health care provider is excluded, he or she is also at risk of being dropped from insurance policies and may also face licensing sanctions.

The Exclusion Process  

Before a person is placed on the LEIE, the OIG will provide the individual with notice and conduct an investigation. The Notice of Intent to Exclude must contain specific information, including:

  • The legal reason for exclusion;
  • Details about the events leading to the proposed placement on the LEIE; and
  • The estimated length of time that the individual could be excluded.

After receiving a notice, a person has the right to request a hearing or present his or her own evidence to the OIG.

How an Experienced White Collar Crime Lawyer can Help  

These types of cases are often won at the investigation level, so if you are a health care professional and are being investigated for committing a white collar crime, please contact Jeffrey S. Weiner, P.A. Criminal Defense Attorneys at 305-670-9919 to speak with an experienced Miami attorney about your case.

Resource:

oig.hhs.gov/exclusions/background.asp

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