The Federal Office of Inspector General (OIG) for the U.S. Department of Health & Human Services (HHS) is tasked with maintaining a database containing a list of individuals and entities that are excluded from participation in Medicare, Medicaid, and other federally funded health care programs. This database of excluded individuals and entities is known as the List of Excluded Individuals/Entities or LEIE. Persons or entities that are listed on the LEIE cannot participate in the Utah Medicaid program and cannot be employed in certain jobs and functions within a provider’s office that is enrolled in the Utah Medicaid program. Providers enrolled in Utah Medicaid cannot employ persons on the LEIE even if they are not directly providing care to Medicaid patients. An individual on the exclusion list cannot serve in a leadership position, and cannot provide administrative or management services, such as health information technology services and support, strategic planning, billing and accounting, staff training, and human resources.
If a Utah Medicaid provider employs an excluded individual or entity in these roles, those Medicaid payments will be recovered and the provider risks having additional assessments and penalties imposed on them. Providers must be aware of the importance of this exclusion rule and must take steps to ensure they do not improperly employ an excluded individual. Utah Medicaid publishes this exclusion policy within the Utah Medicaid Section I: General Information Provider Manual which can be viewed at: https://medicaid.utah.gov/utah-medicaid-official-publications.
For additional information about the HHS OIG exclusion rule, please visit: https://oig.hhs.gov/faqs/exclusions-faq.asp. It is recommended that all providers participating in the Utah Medicaid program conduct regular checks of the LEIE to ensure they are not improperly employing an excluded individual or entity. The LEIE is updated monthly with new exclusion and reinstatement files. You may contact the Utah Office of the Inspector General Policy and Training Coordinator at (801) 538-6018 with additional questions and for providers to request training on the LEIE and Utah Medicaid exclusion policy.
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