Monthly Newsletter

• Screening obligation: Health care providers must screen their employees and contractors against the LEIE to avoid liability. Make it a requirement for applicants and employees to disclose if they are excluded from federal programs and for them to notify you immediately if they become excluded.
• Potential Consequences can be:
  • Monetary Penalties: Your organization can face penalties of up to $10,000 for each item or service provided by the excluded individual for which payment is submitted, plus an assessment of up to three times the amount claimed (treble damages).
  • False Claims Act liability: You may be subject to liability under the False Claims Act for the damages it has suffered.
  • Criminal penalties: In cases of intentional fraud, you could face criminal charges.
  • Exclusion from federal programs: The excluded individual themselves may be subject to further penalties, including extended exclusion from federal programs.
• Conduct Initial Screening upon Hire & Monthly Screening thereafter: The OIG recommends and many payers require monthly screening to stay up-to-date, as a person's exclusion status can change.  Regularly re-screen your employees, contractors, and vendors to catch any individuals who may be added to the list after their initial hiring.
• Searching for individuals: When searching the LEIE, it's important to check former names (like a maiden name) in addition to current names, as there is no cross-reference function for aliases.
• Reinstatement: Excluded individuals must formally apply for reinstatement, which is not automatic. They can apply up to 90 days before their exclusion ends, and the OIG will conduct an investigation as part of the process.

Visit the OIG Exclusions FAQs page for more information and review recent cases provided below.

The government expects your organization to audit and monitor for compliance.  This means taking corrective action from lessons learned within and learning from cases published by the government, which includes reviewing the Department of Justice cases and monthly updates to the OIG Work Plan.

Learning from 2025 exclusion cases - Recent Office of Inspector General (OIG) exclusion cases include a 2025 settlement where a nursing facility paid over $243,000 for hiring an excluded individual, and a January 2025 case where a healthcare professional paid about $41,000 for hiring a banned receptionist who provided billable services. Other cases involve a medical group paying over $581,000 for submitting false claims and an individual being excluded for causing false Medicare claims.  

Additional specific 2025 cases are listed below.

Excluded for 10 Years - Opal Mullings and Optimum Faith Lab Corp.

Effective September 3, 2025, OIG excluded Optimum Faith Lab Corp. and its owner Opal Mullings (collectively, “Optimum”) from participation in all Federal health care programs for a period of 10 years under 42 U.S.C. 1320a-7(b)(7). The exclusions were imposed based on Optimum’s submission of claims for:

1. mileage under HCPCS Code P9603 that were improperly inflated in excess of the actual mileage driven by phlebotomists, not properly prorated, or both;
2. travel allowance when only a fingerstick blood draw was performed, which are not payable collections under Medicare rules; and
3. claims for travel allowance and laboratory services (i.e., clotting tests, catheterizations, venipunctures and A1C tests) that were never rendered.

Employing an Excluded Individual Results in $20,000 Settlement

On September 29, 2025, AccuCare Home Health Services (AccuCare), Mesa, Arizona, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves allegations that AccuCare employed an individual who was excluded from participating in any Federal health care program. OIG alleged that the excluded individual, who worked as a home health aide, provided items or services that were billed to Federal health care programs.

$227,000 and Excluded for 10 years – Ideal Health Diagnostics & Svetlana Dizik

On August 26, 2025, Ideal Health Diagnostics, Inc. (Ideal Health) and Svetlana Dizik (Dizik), Glenview, Illinois, entered into a settlement agreement with OIG in which they agreed to pay $227,193.28 and be excluded from participation in all Federal health care programs for 10 years. The settlement agreement resolves allegations that Ideal Health solicited and received improper remuneration from Perry Rudich, MD in exchange for referrals for radiological interpretive services. Further, Ideal Health and Dizik caused the submission of claims to Medicare which falsely identified Dr. Rudich as the rendering provider for items and services that he did not perform, and for which Ideal Health and Dizik, as the non-enrolled providers of those items or services, could not themselves bill or receive payment from Medicare.

To report a detected excluded individual to the Office of Inspector General (OIG), your organization must use the Provider Self-Disclosure Protocol (SDP), not the OIG Hotline. Self-disclosure is a crucial step to mitigate penalties and resolve potential liability issues. Before making a disclosure, your organization must take the following steps listed below.  We also recommend consulting with legal counsel prior to reporting the incident to the OIG.

1. Conduct a thorough internal investigation

• Confirm the match: Double-check your findings against the OIG's List of Excluded Individuals and Entities (LEIE) to confirm the exclusion match is legitimate. Verify the individual's identity using their Social Security Number (SSN) to avoid confusion with similar names.
• Notify internal stakeholders: Alert your organization's legal and compliance teams immediately.
• Take immediate corrective action: Suspend the excluded individual from all duties involving federal healthcare programs. This is essential to prevent further damage and to demonstrate that your organization is acting swiftly to remedy the issue.
• Gather employment details: Collect specific information about the individual, including:
  • Job duties and responsibilities.
  • Start and end dates of employment or contract.
  • Dates the person was excluded while employed.
  • Description of any background checks performed.
• Calculate damages: Determine the monetary damages caused by the excluded individual's employment. This will involve estimating the amount of federal healthcare program payments (e.g., Medicare and Medicaid) that were improperly billed.
• Review your screening process: Investigate why the individual was not identified before or at the time of hiring. This helps identify any flaws or breakdowns in your screening procedures and is a required component of the disclosure.

2. Prepare the Self-Disclosure Protocol submission

• Submit via the online portal: The OIG recommends using its Provider Self-Disclosure Protocol website to submit the disclosure. Do not use the OIG Hotline, as that is for general complaints and fraud tips.
• Provide a detailed narrative: Your submission must include a thorough summary of all relevant facts, including:
  • The excluded individual's identity, job duties, and employment dates.
  • The specific federal healthcare programs affected.
  • The total damages or overpayment amount.
  • A description of how the conduct was discovered.
  • Details of the corrective actions your organization has already taken.
  • An explanation of any systemic flaws in your screening process and how they were fixed.
• Acknowledge the violation: Your submission must explicitly identify the laws that were potentially violated and acknowledge that the conduct represents a potential violation.

3. Cooperate with the OIG

After submitting the disclosure, be prepared for a waiting period while the OIG reviews the information. The OIG may assess civil monetary penalties (CMPs) and will require the repayment of improperly billed funds. Cooperate fully with any follow-up inquiries from the OIG. Entering the SDP process is meant to be a cooperative effort to resolve the issue, not a litigation venue. However, follow advice from legal counsel regarding CMPs and negotiating a settlement.

Take corrective action to avoid future incidents.  This typically requires compliance training for specific executives within your organizational structure. We recommend online training programs offered by the American Institute of Healthcare Compliance, a Licensing/Certification Partner w/CMS:

• Conducting Internal Investigations
• Auditing for Compliance
• Corporate Compliance Officer Training
• More – click here for a full listing of course offerings. Use coupon code THANKS25 to save 25% through November (restrictions apply).