CMS Pub. 100-18, ch. 9, § 50.6.8

The Act §1862(e)(1)(B), 42 C.F.R. §§ 422.503(b)(4)(vi)(F), 422.752(a)(8),

423.504(b)(4)(vi)(F), 423.752(a)(6), 1001.1901

This section provides guidance regarding sponsors’ implementation of FWA

safeguards to identify excluded providers and entities. Medicare payment may not

be made for items or services furnished or prescribed by an excluded provider or

entity. Sponsors shall not use federal funds to pay for services, equipment or drugs

prescribed or provided by a provider, supplier, employee or FDR excluded by the

DHHS OIG or GSA.

Sponsors must review the DHHS OIG List of Excluded Individuals and Entities

(LEIE list) and the GSA Excluded Parties Lists System (EPLS) prior to the hiring

or contracting of any new employee, temporary employee, volunteer, consultant,

governing body member, or FDR, and monthly thereafter, to ensure that none of

these persons or entities are excluded or become excluded from participation in

federal programs. Monthly screening is essential to prevent inappropriate payment

to providers, pharmacies, and other entities that have been added to exclusions lists

since the last time the list was checked. After entities are initially screened against

the entire LEIE and EPLS at the time of hire or contracting, sponsors need only

review the LEIE supplement file provided each month, which lists the entities added

to the list that month, and review the EPLS updates provided during the specified

monthly time frame.

OIG’s LEIE includes all health care providers and suppliers that are excluded from

participation in federal health care programs, including those health care providers

and suppliers that might also be on the EPLS. In addition to health care providers

(that are also included on the OIG LEIE) the EPLS includes non-health care

contractors.

Links to instructions for accessing this information are available in Appendix A:

Resources.