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| | + | OIG has the authority to exclude individuals and entities from Federally funded health care programs pursuant to sections 1128 and 1156 k of the Social Security Act and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals and Entities (LEIE). Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). |
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| − | LEIE is the abbreviation for List of Excluded Individuals and Entities from the [[Office of Inspector General, U.S. Department of Health and Human Services|Office of the Inspector General]] from the [[United States Department of Health and Human Services | Department of Health and Human Services]].
| + | OIG hat die Befugnis, Einzelpersonen und Körperschaften von staatlich finanzierten Gesundheitsprogrammen gemäß den Abschnitten 1128 und 1156 des Social Security Act auszuschließen und führt eine Liste aller derzeit ausgeschlossenen Einzelpersonen und Körperschaften, die als Liste der ausgeschlossenen Einzelpersonen und Körperschaften (LEIE) bezeichnet wird. Jeder, der eine natürliche oder juristische Person auf der LEIE einstellt, kann mit zivilrechtlichen Geldstrafen (CMP) belegt werden. |
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| − | OIG has the authority to exclude individuals and entities from Federally funded health care programs pursuant to sections 1128 and 1156 k of the [[Social Security Act]] and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals and Entities (LEIE). Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP).
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| − | ==Authority==
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| − | [[Office of Inspector General, U.S. Department of Health and Human Services|Office of the Inspector General]] which is a special division of [[United States Department of Health and Human Services | Department of Health and Human Services]]
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| − | ==Legal Base==
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| − | Social Security Act
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| − | ==Cause and Treatment==
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| − | based on Cause and treatment codes from SYSTEM OF AWARD MANAGEMENT
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| − | there are two reasons:
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| − | ===CT Code Z===
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| − | ====Cause====
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| − | Excluded by the Department of Health and Human Services from participation in Medicare and all state health care programs pursuant to 42 U.S.C. § 1320a-7 or other sections of the Social Security Act, as amended and codified in Chapter 7 of Title 42 of the United States Code.
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| − | ====Treatment====
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| − | Excluded by the Department of Health and Human Services from participation in Title XVIII (Medicare), Title XIX (Medicaid), Title V (Maternal and Child Health Programs) and Title XX (Block Grants to States for Social Services Programs) of the Social Security Act, as amended and codified in Chapter 7 of Title 42 of the United States Code. Pursuant to 42 C.F.R. § 1001.1901, the effect of an exclusion is that payment may not be made by the programs for any items or services furnished, directly or indirectly by an excluded party. In addition, payment may not be made for any items or services furnished, ordered, or prescribed by an excluded physician. Contact the Health and Human Services Point of Contact (POC) shown under the Agency Contact if you need specific information concerning listed parties.
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| − | ===CT Code Z1===
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| − | ====Cause====
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| − | Excluded by the Department of Health and Human Services from participation in Medicare and all state health care programs pursuant to 42 U.S.C. § 1320a-7 or other sections of the Social Security Act, as amended and codified in Chapter 7 of Title 42 of the United States Code. For exclusions imposed before August 5, 1997, the scope of the exclusions encompasses Medicare and all State health care programs.
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| − | ====Treatment====
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| − | Excluded by the Department of Health and Human Services from participation in all Federal health care programs. Federal health care programs include Title XVIII (Medicare), Title XIX (Medicaid), Title V (Maternal and Child Health Programs) and Title XX (Block Grants to States for Social Services Programs) of the Social Security Act, as amended and codified in Chapter 7 of Title 42 of the United States Code, and all other plans or programs that provide health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government (other than the health insurance program under chapter 89 of Title 5 of the United States Code). For exclusions imposed before August 5, 1997, the exclusion is from Title XVIII (Medicare), Title XIX (Medicaid), Title V (Maternal and Child Health Programs) and Title XX (Block Grants to States for Social Services Programs) of the Social Security Act, as amended and codified in Chapter 7 of Title 42 of the United States Code. Pursuant to 42 C.F.R. § 1001.1901, the effect of an exclusion is that payment may not be made by the programs for any items or services furnished, directly or indirectly, by an excluded party. In addition, payment may not be made for any items or services furnished, ordered, or prescribed by an excluded physician. Contact the Health and Human Services Point of Contact (POC) shown under the Agency Contact if you need specific information concerning listed parties.
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| − | ==list specific details==
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| − | ===Waivers<ref>*[https://oig.hhs.gov/exclusions/waivers.asp Waivers OIG]</ref>===
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| − | OIG has the authority to waive an individual or entity's exclusion as a provider from Federal health programs. See Section 1128(c)(3)(B) of the Social Security Act (Act) and 42 C.F.R. 1001.1801(b). Waivers are available only for those excluded providers who are the sole community physician or the sole source of essential specialized services in a community. Waivers cannot be granted to those excluded for patient neglect or abuse. See section 1128(a)(2) of the Act.
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| − | A waiver may be requested only by the administrator of a Federal or State health program. Excluded individuals or entities may not request a waiver from the OIG.
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| − | ===Reinstatement<ref>*[https://oig.hhs.gov/exclusions/reinstatement.asp Reinstatement OIG]</ref>===
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| − | Reinstatement of an excluded individual or entity is not automatic once the specified period of exclusion ends. In order to participate in the Medicare, Medicaid and all Federal health care programs once the term of exclusion ends, the individual or entity must apply for reinstatement and receive written notice from OIG that reinstatement has been granted.
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| − | An individual or entity with a defined period of exclusion (e.g., 5 years, 10 years, etc.) may begin the process of reinstatement 90 days before the end of the period specified in the exclusion notice letter. Requests received earlier than 90 days before the end of the period of exclusion will not be considered.
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| − | ==PST-Identifier==
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| − | HOLEI
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| − | ==References==
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OIG has the authority to exclude individuals and entities from Federally funded health care programs pursuant to sections 1128 and 1156 k of the Social Security Act and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals and Entities (LEIE). Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP).
OIG hat die Befugnis, Einzelpersonen und Körperschaften von staatlich finanzierten Gesundheitsprogrammen gemäß den Abschnitten 1128 und 1156 des Social Security Act auszuschließen und führt eine Liste aller derzeit ausgeschlossenen Einzelpersonen und Körperschaften, die als Liste der ausgeschlossenen Einzelpersonen und Körperschaften (LEIE) bezeichnet wird. Jeder, der eine natürliche oder juristische Person auf der LEIE einstellt, kann mit zivilrechtlichen Geldstrafen (CMP) belegt werden.
