What does “excluded individuals” mean and should I be concerned about them?
Excluded individuals are persons or entities who appear on the List of Excluded Individuals and Entities (LEIE) or the Excluded Persons List System (EPLS). If you are a school-based Medicaid provider submitting claims to the Medicaid agency, you should be concerned about them.
The US Department of Health and Human Services, Office of Inspector General (OIG) maintains the List of Excluded Individuals and Entities (LEIE). The Federal Government’s System for Award Management (SAM) maintains the Excluded Persons List System (EPLS).
It is important to check practitioners who are involved in any way with the Medicaid process, including those practitioners who provide Medicaid reimbursable services and those who authorize/refer Medicaid reimbursable services. (“Practitioners” are defined as those involved in direct patient [student] care, indirect patient [student] care, administrative and management services in relation to Medicaid reimbursements).
EDMS is prepared to assist you with the process that is involved. In a Special Advisory Bulletin from September 1999, the bulletin recommends that Medicaid providers check providers’ names against the list prior to hiring them and periodically after they have been hired. We want to help you avoid being subject to Civil Monetary Penalties by having an excluded individual or agency working for you.
Office of Inspector General – U.S. Department of Health and Human Services
Seach the Exclusions Database
General Services Administration’s Excluded Persons List System (EPLS)
Maine – Program Integrity Excluded Providers
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