Not Conducting Exclusion Checks – Is it Worth the Risk?

Is your organization conducting regular exclusion checks for your vendors and employees?

With the repercussions of contracting or employing an excluded individual or vendor, exclusion checks should be an important part of any organization’s compliance program. Organizations can receive a penalty of up to $20,000 for each billable service conducted after February 9, 2018, and up to $10,000 for any billed services before that date. Those fines can be costly for any organization employing or contracting with an excluded individual or vendor.

In October 2024, one organization agreed to pay $60,000 for employing an excluded individual and another agreed to pay $20,000. Those are just two examples. Visit the Office of Inspector General’s (OIG) Enforcement Actions to read more about those examples and see many others.

As of November 12, 2024, the List of Excluded Individuals/Entities (LEIE) contained 80,934 entries. That is nearly 600 more entries than the previous month! With the number of individuals and entities on the LEIE list, why risk employing or contracting with an excluded individual or vendor?

It is important to note that an excluded individual or entity can take an average of 173 days to appear on the LEIE list and could take up to 2 years to appear on a state list. What this means is you could hire an employee or contract with a vendor that hasn’t been added to an exclusion list yet.

This supports the importance of conducting exclusion checks on a monthly basis as recommended by the General Compliance Program Guidance. It is also important to include state lists in your exclusion check process. Our previously published blog, “Understanding the Difference Between State and Federal Exclusion Check Requirements” provides more detail on state lists and some other information on exclusions.

LW Consulting, Inc. (LWCI) offers an exclusions software with competitive pricing. LWEnSCheck® Exclusions Software is available as a monthly licensing subscription for organizations to complete their monthly exclusions and allows your team to download monthly reports for compliance retention. If your team has been struggling to keep up with monthly exclusions, outsource to our exclusion consultants.

LW Consulting, Inc. (LWCI) offers a comprehensive range of services that can assist your organization in maintaining compliance, identifying trends, providing education and training,  or conducting documentation and coding audits. For more information, contact LWCI to connect with one of our experts!