Comparison between OIG Exclusion List and CMS Preclusion List
OIG Exclusion List vs. CMS Preclusion List
Since the CMS Preclusion list was announced in April 2018, and then published in January 2019, there has been confusion and questions regarding the list, its differences from the OIG Exclusion List, the size of the list, and who has access. Unfortunately, the publication of the list has added further complexity to the already complicated terrain of health care compliance. For that reason, the below article is designed to be a OIG Exclusion List vs. CMS Preclusion List comparison while also providing addition insight into the CMS Preclusion List.
If you are interested in additional information regarding the CMS Preclusion List, click here to read our article titled “What to Know About the New CMS Preclusion List.”
1. Overview
The OIG Exclusion List is a registry of individuals and entities that have been excluded from participation in Federal health care programs. Exclusion may be mandatory in nature or permissive, depending based on the underlying adverse action.
The CMS Preclusion List is a registry of all health care providers, suppliers, and prescribers who are precluded from receiving reimbursement for Part C Medicare Advantage items and services or Part D drugs that are provided or prescribed to Medicare beneficiaries.
2. Purpose
If a health care provider, supplier, or other entity is on the OIG Exclusion LIST, the excluded party cannot provide care or services to Medicare and / or Medicaid beneficiaries. Nor can the excluded party work for a participating provider or serve as an agent, contractor, or vendor for participating provider or supplier.
The CMS Preclusion List was implemented to better ensure patient safety and to protect the integrity of the Medicare Trust Funds from the actions of providers and prescribers that have been identified as “BAD ACTORS.”
3. Who Has Access?
The OIG Exclusion List is available to the public. Providers must also review approximately 43 State Medicaid exclusion databases.
Only CMS approved Part C and Part D Payor plans have with a valid Health Plan ID has been granted access to the CMS Preclusion List database.
4. Size of the Database
As of March, 2022, approximately 75,000 individuals and entities are on the OIG Exclusion List. An additional 85,500 parties are listed on State Medicaid exclusion lists.
Approximately 4,700 individuals and entities are currently listed on the CMS Preclusion List.
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5. Potential Penalties
The improper employment or engagement of an individual on the OIG Exclusion List can result in overpayments, significant Civil Monetary Penalties and a variety of other administrative adverse actions.
The improper payment for services provided or drugs ordered by an individual who has placed on the CMS Preclusion List can result in overpayments and the imposition of Civil Monetary Penalties.
6. Conclusion
It is our hope that the above article helped you distinguish the differences between the OIG Exclusion List vs. CMS Preclusion List. However, we at Exclusion Screening understand that fulfilling your screening requirements can be difficult or impossible to manage on your own. Therefore, we offer best in class screening for both the OIG Exclusion List and the CMS Preclusion List as well as State Medicaid, GSA Sam, and many, many other debarment lists. Email us today at info@exclusionscreening.com or fill out the form below to learn more about our services.