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Ask the Expert: Why should I search the OIG Web site?

Credentialing Resource Center Connection, September 13, 2007

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The Office of Inspector General (OIG) maintains a Web site that includes a database of individuals and entities excluded from federal programs, including Medicare and Medicaid. This database is available free of charge to anyone, including the public, at http://exclusions.oig.hhs.gov. Federal patients can only be treated by healthcare organizations approved (i.e. not excluded) by the OIG, according to corporate compliance requirements. A healthcare organization can be fined up to $10,000 for each service billed by an excluded provider. In addition, no Medicare or Medicaid payment(s) will be made to a facility for services provided by an excluded party. Although most physicians sign a consent form stating that they have not been sanctioned or excluded from a state or federal program, they do not always provide information concerning sanctions or exclusions that occur after appointment.

Federal law states that any entity or individual who is responsible for a sanctioned entity or individual also may be subject to "permissive" exclusion if the entity or individual knows of the actions leading to the sanction and does not exclude that individual from performing services. This "permissive" exclusion allows the agency to use its discretion in deciding whether to impose an exclusion from participating in the federal programs. In addition, it is possible to download cumulative reports and import them into databases or spreadsheet software.

More information can be found in Credentialing and Privileging Desk Reference, Volume One: Physician Directory, by contributing editor Kathy Matzka, CPMSM, CPCS, available here.

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