OIG Background Checks: Everything You Need to Know

Conducting an OIG background check for employment can help healthcare employers mitigate risk, meet industry requirements, and provide quality patient care. An OIG background check searches the OIG exclusion list for individuals or entities banned from participating in federally funded healthcare programs. Organizations that hire employees or contractors on the OIG exclusion list can lose their eligibility for Medicare, Medicaid, and other federal healthcare programs, and may also face sizable fines and penalties. However, employers must be careful to conduct their OIG background checks in compliance with applicable federal, state, and local laws.

An OIG background check is a healthcare background screening that searches the OIG exclusion list for individuals or providers barred from participation in federally funded healthcare programs. How does someone get on the OIG exclusion list? Suspended licenses, financial fraud, and patient abuse or neglect are among the reasons a person or organization may be placed on the exclusion list. Employers that hire employees, contractors, or others on this list may lose eligibility for funding from federal healthcare programs such as Medicare and Medicaid. They may also have to pay civil penalties up to tens of thousands of dollars.

Healthcare industry employers check the OIG exclusion list to help enhance patient care, hire qualified candidates, and maintain their federal funding eligibility. Employers can check the OIG exclusion list online or work with a qualified background check provider, like Checkr, to conduct a comprehensive OIG criminal background check.

Healthcare workers or contractors who typically undergo OIG background screenings include:

The OIG exclusion list, formally known as the List of Excluded Individuals/Entities (LEIE), shows individuals and organizations banned from participating in federally funded healthcare programs, including Medicare and Medicaid. The US Department of Health and Human Services Office of Inspector General maintains the OIG exclusion list. Some OIG exclusions are mandatory; others, called permissive exclusions, are at the discretion of the OIG.

Under Section 1128 of the Social Security Act, the Department of Health and Human Services (HHS) is mandated to exclude individuals or organizations for the following causes:

Permissive exclusions are made at the discretion of HHS and may include:

Conducting OIG screenings can help healthcare employers maintain federal funding eligibility, improve patient care, and mitigate risk. For example, OIG background checks for employment can identify individuals whose licenses have been suspended or revoked, helping safeguard you from hiring unqualified employees. Conducting an OIG background check can also help protect employers from legal liability that could arise from hiring someone known to have abused patients or committed fraud.

Employing an individual, volunteer, or entity on the OIG exclusion list could expose your organization to civil monetary penalties of as much as $10,000 per day that the excluded individual or entity is employed. There may also be penalties of up to $10,000 for each claimed item or service provided, subject to an assessment of up to three times the amount of each claimed item or service. In addition, you could lose your ability to accept federal healthcare program funding such as Medicare and Medicaid payments.

Although OIG background checks for employment can be vital to protecting your organization and your patients, it’s important to follow all applicable federal, state, and local laws when conducting your background screenings.

You can conduct OIG background checks by searching the OIG Exclusions database or working with a trusted consumer reporting agency (CRA) to handle the search for you. Employers who choose the do-it-yourself option will need the individual’s Social Security number (SSN) or the entity’s Employer Identification Number (EIN).

When performing an OIG background check for five or fewer individuals or organizations, you can search the OIG Exclusions list online. Employers who are screening large numbers of individuals or entities at once may find it easier to download the OIG LEIE database. However, the downloaded database doesn’t include SSNs or EINs, which can make accurately verifying results challenging, and the interface can be unwieldy.  With either search method, it’s important to search under all the names and name variations a person or organization may have.

The OIG exclusion list is updated once per month based on information provided by state exclusion lists. Because each state may send updates to HHS at a different time of the month, an individual or entity with healthcare sanctions or exclusions in their state may not appear on the OIG exclusion list immediately. For the most complete results, you may also want to check state Medicaid exclusion lists, which can be time-consuming. HHS also recommends checking the OIG exclusion list monthly to ensure you have the most current data. Employers can do this by checking the LEIE manually each month or requesting email notifications whenever the list is updated.

In addition to the OIG list and state exclusion lists, you may wish to check other federal databases listing exclusions, sanctions, and penalties, suspensions, or disciplinary action that has been taken against an entity or individual. These include searching the System for Award Management (SAM), a database of federal contractors maintained by the U.S. General Services Administration (GSA). An OIG SAM background check can show whether a contractor is excluded from working with the federal government.

Enlisting a CRA, like Checkr, to perform an OIG check can streamline your healthcare screening process and deliver faster, more accurate results compared to performing your own background checks. Checkr’s built-in compliance tools help you create customized workflows tailored to any screening level your healthcare organization requires, with comprehensive OIG and GSA background checks that include searching the SAM database, the OIG exclusion list, and many other federal databases, as well as state-specific Medicaid and Medicare exclusion lists. 

Checkr also offers recurring healthcare sanctions checks to provide peace of mind. Since using Checkr, 95% of healthcare customers say they’ve experienced a simplified workflow; 86% say they’ve experienced faster turnaround and a better candidate experience.

Federal OIG background check requirements, as well as state laws and regulations, may vary depending on the specific healthcare employer. When performing healthcare background checks, employers should consult their legal counsel and be mindful of the following federal laws.

Section 1128 of the federal Social Security Act specifies reasons for mandatory or permissive exclusions and how long they last. Mandatory OIG exclusions last for five years. An individual or entity that receives two mandatory exclusions will be on the OIG LEIE for ten years; three exclusions place the offender on the list permanently. In general, permissive exclusions last three years or less.

Section 1156 of the Social Security Act defines the responsibilities of any healthcare provider receiving funding from federal healthcare programs; examples include providing only services that are medically necessary and meet professional standards.

Although no law requires healthcare industry employers to check the OIG exclusion list, failing to do so may increase risk of legal liability, penalties, and fines. Following OIG compliance guidance for specific healthcare industry segments, including hospitals, nursing homes, and suppliers of durable medical equipment, can help your organization maintain OIG standards.

All employers who partner with a CRA must follow the federal Fair Credit Reporting Act (FCRA) when using information from a background check in their hiring processes. The FCRA requires employers to give candidates written notice that they plan to perform a background check and obtain their written permission to do so. If you intend to take negative action against a candidate or employee based on the results of a background check, including an OIG check, the FCRA requires that you follow the adverse action process.

The Equal Employment Opportunity Commission (EEOC) enforces federal laws prohibiting discrimination in employment based on race, sex, color, religion, national origin, pregnancy, gender identity, sexual orientation, age, disability, and genetic information. If making hiring decisions based on the results of a criminal background check, the EEOC recommends considering the nature of the offense, when it took place, and its relevance to the job in question to mitigate potential discrimination against protected classes.

Under the Americans With Disabilities Act (ADA), employers may not ask questions related to disabilities as part of a background check and cannot require a medical exam until a conditional offer of employment is made. Employers are also prohibited from discriminating against candidates who have a history of substance abuse, are currently in recovery, or are undergoing rehabilitation.

Let’s take a look at some of the most commonly asked questions about OIG background checks, the OIG exclusion list, and healthcare sanctions checks.

Healthcare industry employers may wish to run OIG background checks when hiring employees or contractors or vetting volunteers. Because the OIG exclusion list is updated regularly, the OIG also recommends conducting OIG checks of employees, contractors, and volunteers on a monthly basis.  

Employers should check the OIG exclusion list at least once per month for the most current results. The OIG exclusion list is updated monthly based on information provided by the states. Because a recently sanctioned individual or entity may not appear on the OIG exclusion list immediately, employers may also want to check state Medicaid exclusion lists when hiring. If you work with a background check partner, like Checkr, you may be able to automate monthly OIG list re-checks.

A person or entity typically gets added to the OIG exclusion list for Medicare, Medicaid, or other healthcare fraud, patient abuse, or neglect. Other reasons someone might appear on the OIG exclusion list may include:

The Office of Inspector General (OIG) is an independent entity that prevents fraud and mismanagement in US General Services Administration (GSA) operations and programs. Regarding OIG and GSA background checks, the OIG maintains the OIG exclusion list, while the GSA maintains the System for Award Management (SAM) database of federal contractors. Conducting both a SAM background check and an OIG check may be required and can help healthcare employers avoid hiring individuals or entities prohibited from receiving federal healthcare program funds.

OIG background checks can help healthcare employers maintain quality patient care and mitigate legal risk. However, checking the OIG exclusion list and other lists of individuals and entities with healthcare sanctions can be a highly manual process. You can simplify your healthcare sanctions and OIG background check process by partnering with Checkr.

Checkr offers multiple OIG background screening options for employers and candidates, including comprehensive searches of state and federal government databases. Checkr’s modern platform delivers fast, accurate OIG background check reports at any scale. Our ongoing OIG checks provide peace of mind, while our technology integrates seamlessly into your workflow. Save time and effort without sacrificing safety. Get started with Checkr.

About the author

Karen Axelton writes about business topics and best practices. She has written hundreds of articles on business subjects, including background screening, hiring and employment trends, human resource management, and the use of technology in the workplace. Her work includes educational articles, e-books, white papers, and case studies.