OIG Check, OIG Excluded, and OIG Exclusion Explained in Simple Language

In order for people with OIG Check, OIG Excluded, OIG Exclusion, and Exclusions List from the OIG, People may get confused by these terminologies; however, these concepts are very simple in nature and provide an explanation in language the average person will understand about its significance and importance. This blog will help you understand each of them.

What Are OIG Checks?

OIG Checks are the primary way that healthcare organizations verify that someone has the right to provide services through government-funded healthcare programs such as Medicare and Medicaid. The OIG is the Office of Inspector General and is a government agency that oversees the investigation of healthcare fraud and abuse.

Healthcare providers typically conduct the OIG Check before hiring employees, onboarding new physicians, or entering into vendor agreements. They may also periodically perform the OIG checks throughout the life of a business to ensure that they continue to operate according to OIG regulations.

Who Is Defined As OIG Excluded?

A person/business will be labelled as OIG excluded when they officially become excluded from participating in federal healthcare programs. This means that no Company will be allowed to deliver services to a patient or provide billing/receiving money directly associated with any federally funded healthcare program (Medicare, Medicaid, etc.

Most OIG exclusions are the result of serious behaviour that has occurred within the healthcare industry, including but not limited to healthcare fraud, submitting false claims, patient abuse, suspending a particular healthcare provider's ability to practice medicine due to violations of their state's medical licensing laws, and unethical conduct as a healthcare provider or administrator. Additionally, repeated violations of the same regulations/laws and having a record of wrongdoing may also be the reason for an individual being excluded from federal healthcare programs.

Theory of OIG Exclusion

Office of Inspector General (OIG) Exclusion refers to the official action taken by OIG that prevents someone from participating in federally sponsored healthcare programs. There are two basic kinds of exclusions: obligatory and discretionary.

Obligatory exclusions are applied to any person who has committed an exceptionally serious crime, such as a criminal act involving Medicare or Medicaid fraud. Discretionary exclusions apply to persons who do not maintain adequate professional standards or who engage in some type of improper behavior within their profession that does not involve the commission of an extremely serious crime.

Once a person has been excluded from a federally funded healthcare program, that individual or organization remains excluded for a period defined by law or until that person requests reinstatement and is approved for reinstatement by OIG.

What does the OIG Exclusions List contain?

The OIG Exclusion List is a publicly accessible database that gives the names of any person or entity that is currently banished from receiving federal funds through Federal Health Care programmes. This database will provide the beginning date of each organisations exclusion as well as an explanation of the reasons that lead to this exclusion.

All Healthcare Organizations must audit the  Exclusions List OIG  on an ongoing basis. Healthcare Organizations that hire or utilize a person listed on the OIG Exclusions List will be liable for penalties and/or demands for repayment regardless of their ignorance. 

The Importance of OIG Checks

OIG Checks regularly help protect healthcare organizations from significant risk. By hiring or contracting with someone who is OIG excluded could result in hefty financial penalties, audits, payments being denied, and damaged reputation.

Through regular OIG checks an organization can:

• Remain compliant with the healthcare regulations

• Avoid expensive fines and lawsuits

• Preserve patient trust

• Uphold its ethical standards

This is why an OIG check is generally a component of most compliance programs.

What to Consider as Frequency for OIG Check List?

There are no set legal requirements; however, the majority of compliance experts agree that you should conduct OIG Check once a month. Doing so will allow an organization to quickly discover any new exclusions that may have developed since the last time they checked and make necessary corrections when required.

Employees, physicians, contractors and vendors who have an impact on patient care or billing should be included in your regular OIG Check List Verification Process.

In Conclusion

Having a basic understanding of what an OIG Check is, or OIG Excluded, or OIG Exclusion as it relates to the Exclusion List, does not need to be complicated. The sole purpose of these at-home measures is to provide assurance, integrity and protection within the healthcare industry. By conducting OIG Checks on a regular basis and by being well informed and educated, healthcare organizations will be able to lessen the risk of wrongdoing and conduct their business with greater confidence while continuing to abide by applicable regulations.