OIG Plans to Modernize LEIE, Prioritize Equity; DOJ Won’t Pursue Small PRF Mistakes

It may take a little time, but the HHS Office of Inspector General (OIG) plans to update the machinery of exclusion screening, which is designed to identify people and entities that are prohibited from billing federal health care programs. Modernizing the List of Excluded Individuals and Entities (LEIE) is part of a broader initiative on program integrity and compliance information and communications, Principal Deputy Inspector General Christi Grimm said April 19 at the Health Care Compliance Association’s Compliance Institute.[1]

OIG’s LEIE, which is visited 26 million times annually, often requires a manual process, and “we are considering how best to adopt modern data-sharing practices for the LEIE, such as application programming interfaces, also known as APIs,” Grimm said. “Modernized LEIE information will mean that data are easier to access through compliance software and apps that use APIs and can support the development of new tools and approaches to compliance.” Exclusion screening is fundamental to compliance programs, and billing for items or services ordered or provided by excluded people and entities puts organizations at risk of civil monetary penalties.

Grimm said OIG needs insights from the industry on modernizing the LEIE and other compliance and program integrity information it has published over the years, including compliance program guidance, fraud alerts, advisory opinions and advisory bulletins. “Your feedback will be critical as we plan to make it as useful and meaningful to you,” she said, adding “we anticipate a multiyear effort.”

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