Glossary
Mandatory and permissive exclusion
The two kinds of OIG exclusion. A mandatory exclusion is required by law after certain convictions and lasts at least five years; a permissive exclusion is imposed at OIG’s discretion on other grounds.
What to know
- Mandatory grounds: convictions for Medicare or Medicaid fraud and other program-related crimes, patient abuse or neglect, felony health care fraud, and felony offenses involving controlled substances.
- A second mandatory offense means at least ten years. A third leads to exclusion with no end date.
- Permissive grounds include license revocation or surrender, misdemeanor health care fraud, false claims, kickbacks, unnecessary or substandard services and default on health education loans.
- The LEIE records the authority used for each entry as a code, such as 1128a1 or 1128b4.
Official sources
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