What OIG's monthly screening guidance actually says

HHS-OIG recommends screening employees and contractors against the LEIE every month, and states that providers are not required by statute or regulation to check the LEIE. In its Updated Special Advisory Bulletin on the Effect of Exclusion, OIG says: “OIG updates the LEIE monthly, so screening employees and contractors each month best minimizes potential overpayment and CMP liability.”

Is monthly LEIE screening required?

No, according to HHS-OIG: “Providers are not required by statute or regulation to check the LEIE.” Monthly is OIG's own recommendation for minimizing risk, not a legal mandate, and this site won't tell you otherwise. The same bulletin records that CMS's January 2009 State Medicaid Director Letter recommended that States require providers to screen employees and contractors monthly, and that CMS's 2011 final regulations mandate that States screen all enrolled providers monthly. It also records CMS's clarification that this regulation does not mandate States to require their Medicaid providers to screen their own employees and contractors, and that CMS recommends States consider doing so. If you are enrolled in a state Medicaid program, check that program's own terms.

Why does the LEIE's monthly refresh matter?

Because the list is replaced every month. HHS-OIG's exclusions FAQ states that “both versions of the LEIE are generally updated by the middle of each month,” so a screen run in June answers “who was excluded as of June” and says nothing about July. That is the logic behind checking monthly rather than once: the list you checked against has, by design, already been updated.

Who counts as workforce and vendors?

HHS-OIG's bulletin says the test is the job category or contract, not the job title: where the item or service is “directly or indirectly, in whole or in part, payable by a Federal health care program,” the best mechanism for limiting CMP liability is to screen “all persons that perform under that contract or that are in that job category.” Its own examples are nurses supplied by a staffing agency, a physician group contracted to cover a hospital's emergency room, and billing or coding contractors. It also states that an excluded person may not provide payable services regardless of whether the person is “an employee, a contractor, or a volunteer or has any other relationship with the provider.”

What would a review of your screening look at?

Our characterisation, not an OIG statement: the practical questions are whether everyone in scope was checked, and whether there is a dated record showing when each check happened relative to the LEIE version in effect that month. A single check for one name, run once, doesn't answer either question for the organization as a whole, or for the months since. What holds up is a dated record, repeated on a schedule, covering the whole roster.

What does doing it properly involve?

Our characterisation: the same full list of employees, contractors, and relevant vendors, checked against a current copy of the LEIE (and, for many practices, SAM.gov and any applicable state list) on a recurring monthly schedule, with each month's result kept on file with its date. That is a standing process, not a one-off name lookup.

One way to do this without building it yourself is a monthly screening service — C.F.A.I.'s monthly screening service, for example, runs the whole roster every month and keeps the dated record.

Sources

• HHS-OIG, Updated Special Advisory Bulletin on the Effect of Exclusion (2013)
• HHS-OIG, Exclusions Program FAQ
• CMS, State Medicaid Director Letter #09-001 (January 2009)

Where this page says “our characterisation,” “our reasoning,” or “we measured,” the statement is CFExclusion's own rather than a government source's. CFExclusion is a private service and is not affiliated with HHS, OIG, CMS, or SAM.gov.