Summary:
This article reviews the MED (Medicare Exclusion Database), which is a private list of individuals and entities excluded from federally funded healthcare programs due to serious violations like fraud or license revocation. It is maintained by CMS under OIG oversight, it helps hospitals avoid hiring excluded parties, which can lead to penalties, fund repayments, or legal issues. Access to MED is not included in ProviderTrust’s standard Exclusion Monitoring and requires a Delegation Agreement.
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The MED (Medicare Exclusion Database) is a private list (not publicly available) that ProviderTrust monitors. It is a part of the Office of Inspector General’s (OIG) List of Excluded Individuals/Entities (LEIE). It contains individuals and entities excluded from federally funded healthcare programs like Medicare and Medicaid due to serious infractions, like:
- Fraud
- Patient abuse
- License revocation
- Controlled substance violations
Who Maintains it?
- CMS (Centers for Medicare & Medicaid Services), but it's driven by OIG oversight.
Why it Matters?
- Hospitals and healthcare systems that employ or contract with someone on this list can face severe penalties, including:
- Civil monetary penalties
- Repayment of reimbursed funds
- Potential criminal liability
How Alerts are Returned:
Based on NPI and TIN matching, a Match or No Match result will be returned based on those unique identifiers. If NPI or TIN are not provided, any match on a partial SSN or location information will be returned as a Suspected Match.
**Please Note: The MED (Medicare Exclusion Database) is not encompassed within the Exclusion Monitoring package; it is an additional feature that requires the ProviderTrust client to supply a Delegation Agreement.
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