List of Excluded Individuals and Entities (LEIE) Office of Inspector General

1
List of Excluded Individuals and
Entities (LEIE) Office of
Inspector General

• Chief Business Office Purchased
  Care
• Department of Program Integrity
  (DPI)

July 2013
2
Objectives

• At the end of this training you should be able
  to
• Summarize and describe the LEIE
• List ways in which the LEIE impacts our VA
  Mission
• Identify ways fraud is committed by individuals
  or entities on the LEIE
• Validate LEIE information on the internet

3
LEIE

• What is the LEIE
• A List of Excluded Individuals and Entities who
  have been excluded from Federally funded health
  care programs or other Federal funded programs.
• The US Department of Health and Human Services
  Office of Inspector General (OIG) has the
  authority to exclude individuals and entities
  from Federally funded health care programs or
  other Federal funded programs.

4
LEIE
httpexclusions.oig.hhs.gov/
5
LEIE

• LEIE Authority
• Title XI of Social Security Act 1128, 1156
• 42 U.S.C. 1320a7a
• 42 U.S.C. 1320c5

6
LEIE

• Mandatory Exclusions
• OIG required by law to exclude
• Hiring of LEIE individuals or entities are
  subject to civil and monetary penalties

7
LEIE

• LEIE Fraud
• The National Provider Identifier (NPI) and the
  Taxpayer Identification Number (TIN)
• Excluded Providers or entities commit fraud by
  using
• Provider Group TIN or NPI
• Facility TIN or NPI

8
LEIE

• LEIE Fraud (contd)
• Excluded Providers or entities will commit health
  care fraud by using
• A different name (maiden, previous married,
  hyphenated name)
• Their personal Social Security number instead of
  a TIN or NPI

9
Conclusion

• Summarized and described the LEIE
• Listed ways in which the LEIE impacts the VA
  Mission
• Identified ways fraud is committed by individuals
  or entities on the LEIE
• Validated how to find LEIE information on the
  internet

10
LEIE

• References, Resources and Links
• https//oig.hhs.gov/exclusions/background.asp
• http//www.ssa.gov/OP_Home/ssact/title11/1128.htm
• http//www.ssa.gov/OP_Home/ssact/title11/1156.htm
• https//oig.hhs.gov/fraud/report-fraud/index.asp

11
References

• Veterans Affairs manages several health care
  programs that reimburse private health care
  providers for caring for our Veterans and their
  eligible family members. Unfortunately, these
  health care programs have a different statutory
  and regulatory authority, which creates diverse
  payment methodologies. The majority of VA health
  care programs utilize Medicares payment
  methodologies or something very similar.
• Therefore, providers and facilities that utilize
  Medicares billing and coding guidelines will
  greatly minimize claim delays or rejections as a
  result of the Program Integrity Tools Improper
  Payment Review.
• The following Medicare link is an excellent
  source of billing and coding guidance for all
  providers and facilitiesMedicare Claim
  Processing Guide
• http//www.cms.gov/Regulations-and-Guidance/Guidan
  ce/Manuals/Downloads/clm104c01.pdf