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List of Excluded Individuals and Entities (LEIE) Office of Inspector General

List of Excluded Individuals and Entities (LEIE) Office of Inspector General. Chief Business Office Purchased Care Department of Program Integrity (DPI). July 2013. Objectives. At the end of this training you should be able to:

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List of Excluded Individuals and Entities (LEIE) Office of Inspector General

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  1. List of Excluded Individuals and Entities (LEIE) Office of Inspector General Chief Business Office Purchased Care Department of Program Integrity (DPI) July 2013

  2. Objectives • At the end of this training you should be able to: • Summarize and describe the LEIE • List ways in which the LEIE impacts our VA Mission • Identify ways fraud is committed by individuals or entities on the LEIE • Validate LEIE information on the internet

  3. LEIE • What is the LEIE: • A List of Excluded Individuals and Entities who have been excluded from Federally funded health care programs or other Federal funded programs. • The US Department of Health and Human Services Office of Inspector General (OIG) has the authority to exclude individuals and entities from Federally funded health care programs or other Federal funded programs.

  4. LEIE • http:exclusions.oig.hhs.gov/

  5. LEIE • LEIE Authority: • Title XI of Social Security Act 1128, 1156 • 42 U.S.C. 1320a–7a • 42 U.S.C. 1320c5

  6. LEIE • Mandatory Exclusions: • OIG required by law to exclude • Hiring of LEIE individuals or entities are subject to civil and monetary penalties

  7. LEIE • LEIE & Fraud: • The National Provider Identifier (NPI) and the Taxpayer Identification Number (TIN) • Excluded Providers or entities commit fraud by using: • Provider Group TIN or NPI • Facility TIN or NPI

  8. LEIE • LEIE & Fraud (cont’d) • ExcludedProviders or entities will commit health care fraud by using: • A different name (maiden, previous married, hyphenated name) • Their personal Social Security number instead of a TIN or NPI

  9. Conclusion • Summarized and described the LEIE • Listed ways in which the LEIE impacts the VA Mission • Identified ways fraud is committed by individuals or entities on the LEIE • Validated how to find LEIE information on the internet

  10. LEIE • References, Resources and Links: • https://oig.hhs.gov/exclusions/background.asp • http://www.ssa.gov/OP_Home/ssact/title11/1128.htm • http://www.ssa.gov/OP_Home/ssact/title11/1156.htm • https://oig.hhs.gov/fraud/report-fraud/index.asp

  11. References Veterans Affairs manages several health care programs that reimburse private health care providers for caring for our Veterans and their eligible family members. Unfortunately, these health care programs have a different statutory and regulatory authority, which creates diverse payment methodologies. The majority of VA health care programs utilize Medicare’s payment methodologies or something very similar. Therefore, providers and facilities that utilize Medicare’s billing and coding guidelines will greatly minimize claim delays or rejections as a result of the Program Integrity Tools Improper Payment Review. The following Medicare link is an excellent source of billing and coding guidance for all providers and facilities:Medicare Claim Processing Guide http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c01.pdf

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