OIG background check for healthcare staff and contractors

An OIG background check searches the HHS Office of Inspector General's List of Excluded Individuals/Entities (LEIE) for current federal healthcare program exclusions. It checks exclusion status, not a complete criminal history (OIG's exclusions FAQ).

A clear LEIE result does not clear state sanctions or other sanction lists. Mandatory exclusions remain with OIG. That FAQ says implementation details for exclusions under authority delegated to CMS are still under development, so the search is not proof that every CMS exclusion is already listed.

For healthcare employers, the 2013 Updated Special Advisory Bulletin recommends screening before hiring or contracting, then monthly. A matching name still needs identity verification before you treat the person as excluded. The steps are in the LEIE verification instructions.

Who needs OIG exclusion screening?

Start with the work, not the job title. OIG recommends reviewing each job category and each contract for work payable by a federal healthcare program, directly or indirectly, wholly or partly. Where that applies, screen everyone performing the work, including contractors, subcontractors and contractors' employees, under the test in the 2013 bulletin.

Screening is not limited to licensed clinicians. The bulletin includes billing and coding, transportation, and administrative work, even when the service has no claim line of its own. That still doesn't pull in every vendor on every contract. Assess the work the contract actually covers.

A staffing agency's screening doesn't hand your liability to the agency. OIG says to validate the contractor's checks, for example by asking for the screening records and keeping them. Don't stop at an assurance that the names were run (OIG bulletin).

How to run an OIG background check

Search the official LEIE

Use the official OIG exclusion search for the OIG background search. The page opens without a login or a payment step. The LEIE instructions allow up to five names in one search.

Check former names and other variations. The file holds the name OIG knew at exclusion, so a search on the current name alone can miss the record.

A no-result search is not employment clearance. Exclusions also come from noncriminal grounds, including a suspended or revoked license, so a clean criminal check doesn't prove the person is off the LEIE (OIG's exclusion background page).

Verify possible matches

A first-and-last-name match is not enough. Open the Verify link. Match an individual on a Social Security number, or an entity on an Employer Identification Number. If that identifying information is missing, the result stays unresolved. Contact OIG's Exclusions Branch for anything else they can provide, rather than marking a mismatch. Those steps are in OIG's verification instructions.

Keep a record of the search

Keep the first name search and any verification searches. Use Print Search Results. The browser's print function will not work (LEIE instructions).

For an internal log, note the date, names searched, result, reviewer and how the possible match was resolved. That is a working log, not a federal form. Don't keep full SSNs or EINs if you don't need them.

Use a current download for bigger workforces

For a larger workforce, use the full downloadable LEIE. OIG recommends the updated full database rather than relying only on the monthly incremental files. If you download the database each month, do not use the monthly supplement files in place of that full file.

The download has no SSNs or EINs. You still verify possible matches online, as the OIG FAQ explains.

Are monthly OIG checks required?

OIG recommends monthly screening for employees and contractors. Its bulletin states that providers are not required by statute or regulation to check the LEIE. OIG updates the list each month, and that bulletin says monthly screening best minimizes potential overpayment and civil monetary penalty liability. Read that as OIG's general guidance, not as a finding that your contracts or state rules are silent.

State Medicaid agencies have a separate duty. 42 CFR 455.436 requires them to check the LEIE and EPLS at least monthly for providers and for the listed ownership, control, agent and managing-employee categories. The regulation still says EPLS. In July 2012, GSA moved the Excluded Parties List System into the System for Award Management (SAM). SAM includes OIG exclusions and debarments from other federal agencies. OIG recommends the LEIE as the primary source for OIG exclusions, ahead of SAM (2013 bulletin).

CMS clarified, in that bulletin, that this Medicaid rule does not require states to make providers screen employees and contractors against the LEIE each month. It is not a monthly staff-screening order for every employer. CMS did recommend that states consider requiring the check, including for managed care entities. State rules, participation terms, contracts and a corporate integrity agreement can still add duties. The general recommendation doesn't settle those.

What happens after a confirmed exclusion?

Federal healthcare program payment is generally prohibited for items or services an excluded party furnishes, orders or prescribes, and having someone else submit the claim does not remove that restriction. OIG's FAQ describes narrow exceptions and waivers, so check the exclusion in front of you rather than assuming every exclusion works the same way.

Bundled payments, and services that are not billed separately, can still create overpayment exposure. Civil monetary penalty liability has its own conditions. The rules cover employing or contracting with a person the employer knows, or should know, is excluded, when the work is payable by a federal healthcare program. Hiring an excluded person is not an automatic fine. See the OIG bulletin and 42 CFR 1003.200.

If the person already works for you, escalate a confirmed exclusion to legal or compliance and have them assess the affected work and payments. Taking them off future work doesn't fix past exposure. The OIG FAQ tells employers who have already employed an excluded person to check the Self-Disclosure Protocol.

RegAffairs AI's explanation of OIG background checks covers the same questions, but the official LEIE is still where you search and verify identity.

The exclusion period ending is not reinstatement. The person or entity must apply, and OIG must grant reinstatement in writing. A provider number from a Medicare contractor, a state program or another federal healthcare program is not enough (OIG reinstatement FAQ).