How the exclusion figures are made

What the list is

The List of Excluded Individuals and Entities is the HHS Office of Inspector General’s list of the people and organizations it has excluded from Medicare, Medicaid and every other federal health care program. OIG says it “provides information to the health care industry, patients and the public regarding individuals and entities currently excluded”. OIG replaces the full file each month, and every figure on these pages is counted from it.

A row is an exclusion, not a person

Each row of the file is an exclusion action: OIG excluded a person or an organization under an authority on a date. A person excluded twice is two rows, and every count here counts rows, which the pages call exclusions. The file tells a person from an organization by its name fields: a person has a last and first name, an organization a business name alone. It held 80,627 exclusions of individuals and 3,466 of organizations.

An exclusion is not a finding of what a person did. The file does not say whether an exclusion was appealed or upheld, and no page here gives a cause for a count by state or by authority.

The authorities OIG cites

Each exclusion names the section of the Social Security Act it was imposed under. Section 1128(a) holds the mandatory exclusions and section 1128(b) the permissive ones; section 1156 covers findings by Quality Improvement Organizations. Each authority’s description on these pages is OIG’s own, from its exclusion authorities table, quoted and never paraphrased. The file uses 22 codes, and a code OIG’s table does not describe is printed as the code alone, with no meaning guessed for it.

Counts of fewer than 11 individuals are withheld

Where a state, an authority or a year has between one and ten exclusions of individuals, neither that count nor the total it is part of is shown, so the one cannot be found from the other. Where a list’s total is printed and its withheld rows could still be worked out from it, one more row is withheld: a year, or an authority within its kind. Counts of organizations print at any value. The national totals include every withheld row. 3 of the places the file names are withheld.

A year’s page prints each place’s exclusions from that year, and those figures add up two ways: across the places to the year’s total, and across the years to the place’s. A place’s figure for a year is withheld where it has one to ten individuals, where its year or its place has its total withheld, and wherever either total would otherwise give a withheld figure back. A year whose own total is withheld has no page.

The state on an exclusion

The state is the one on the exclusion’s row, from the address OIG recorded, not necessarily where the person or organization is now. 82 exclusions carry a foreign address and are counted in no state. A rate per 100,000 residents divides a state’s exclusions by the Census Bureau’s population estimate for the state; it is not a rate of anything a resident did.

Reinstated names leave the list

OIG removes a person or organization from the file when it reinstates them, so every row here is an exclusion in effect, and a count by year is today’s exclusions by the year each took effect, not the number OIG imposed that year. A reinstated name leaves these pages with the next monthly load.

A name is not an identity

The file has no Social Security or employer number. OIG says: “It is not sufficient to simply find a matching first and last name on the LEIE.” No individual has a page here, and no date of birth, street address or ZIP code is shown. To check one person or organization, use OIG’s own search of the list.

What the list leaves out

The file holds OIG’s exclusions only: exclusions by CMS, by the states and by other authorities are not in it. It carries no payment data, so it does not show what an excluded person or organization was paid before or after the exclusion. The year series begins in 1977 and is thin before the late 1990s.

OIG is named as the publisher and its list linked on every page. Neither HHS nor OIG endorses this site, and no seal or logo of theirs is used.

What this data cannot show

• An exclusion is an action OIG took, not a finding of what a person did: the file does not say whether it was appealed or upheld, and a person excluded twice is two rows.
• The list holds OIG's exclusions only; exclusions by CMS, the states and other authorities are not in it, and the file carries no payment data.
• A name on the list is not an identity: the file has no Social Security or employer number, and OIG says a matching first and last name is not enough.

Sources

• List of Excluded Individuals and Entities (LEIE) — U.S. Department of Health and Human Services, Office of Inspector General · Public domain — U.S. Government work · Updated: Monthly; OIG replaces the full database file by the 10th of each month