What is the LEIE, the federal exclusion list NEMT providers must screen?
The List of Excluded Individuals/Entities (LEIE), often shortened to the OIG exclusion list, names every person and company the HHS Office of Inspector General has barred from federal health care programs. Medicaid pays for nothing an excluded person furnishes, and that covers driving, dispatch, and billing work. Providers screen owners, staff, and contractors before hiring and then every month, because OIG adds new names every month.
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What lands someone on the list
OIG’s power to exclude people and businesses comes from Social Security Act section 1128. Some exclusions are mandatory: a conviction tied to Medicare or Medicaid, patient abuse or neglect, a health care fraud felony, or a felony involving controlled substances. Each of those carries a minimum of five years. Other exclusions are permissive, meaning OIG may act after events such as losing a license, obstructing an audit, or fraud and kickbacks.
The effect reaches past the excluded person. No federal health care program pays for anything that person furnishes, orders, or prescribes, no matter who submits the claim. OIG’s 2013 bulletin says excluded people may not provide federally paid transportation, and it names ambulance drivers and ambulance company dispatchers. A driver on the list makes every Medicaid trip they run unbillable for the company that sent them.
Federal Medicaid law also has a rule aimed squarely at NEMT. Since the Consolidated Appropriations Act, 2021, Social Security Act section 1902(a)(87) has made each state put a mechanism in place showing that every NEMT company and individual driver it pays is off the exclusion lists. The law allows the state to rely on attestation for this check, so a broker or plan may ask you to certify that your owners and drivers were screened.
Who to screen, and when
| Person | When to check | What is at stake |
|---|---|---|
| Owners, officers, managing employees | Before enrolling, then monthly | State Medicaid agencies run them against the LEIE and SAM every month or more often (42 CFR 455.436), so an excluded owner puts the whole enrollment at risk |
| Drivers, attendants, dispatchers | Before the first trip, then monthly | Their work is the billed service |
| Billing, office, and management staff | Before hire, then monthly | Administrative work falls under the exclusion too |
| Contractors and subcontracted providers | At signing, then ask for their monthly results | OIG expects contractors screened the same way and suggests keeping their screening records |
Monthly matches OIG’s schedule. The LEIE is generally updated by the middle of each month with every action taken the month before. Owner screening also ties into your screening risk level and your driver background checks.
The lists to search
| List | Kept by | What it covers |
|---|---|---|
| LEIE | HHS OIG | OIG exclusions only. The online search takes five names at a time, and the full list downloads as a CSV with monthly supplements. |
| SAM.gov exclusions | U.S. General Services Administration | Debarments by many federal agencies, OIG exclusions among them |
| State Medicaid exclusion list | Your state, such as the Texas HHS OIG or New York OMIG | People and companies the state itself has barred |
Contracts can name the lists for you. Louisiana’s manual has the broker search the LEIE, the Louisiana Adverse Actions List, and SAM every month and report any exclusion to the state within three business days.
What a missed match costs
Under 42 CFR 1003.210, OIG can fine a provider for each item or service an excluded person furnished. HHS’s current inflation table puts that maximum at $25,595 per item or service. OIG can add an assessment of up to three times the amount claimed, or for work that is not billed separately, such as office work, up to three times what the person cost you in pay, benefits, and taxes. The payments themselves become overpayments you have to return, which starts the clock under the 60-day overpayment rule.
For example, a driver who ran 200 Medicaid trips before anyone caught the match leaves 200 separate services exposed, not one.
Keep a dated record of every search: who ran it, which names, which lists, and the result. A driver file checklist is a good home for it.
Where software fits
Exclusion searches run on OIG, SAM, and state sites. HealthRide tracks the rest of each driver’s credentials and their expiration dates in one fleet and credentials registry, sends reminders before a date lapses, and flags anything expired when a trip is assigned.
Frequently asked questions
- Is there a federal law that makes providers check the LEIE?
- Not directly. OIG says no statute or regulation makes providers run the check, but it recommends screening employees and contractors every month because that best limits overpayment and penalty exposure. States and contracts close the gap. Texas ties enrollment and revalidation to the monthly check, Louisiana has its broker search the LEIE, SAM, and its own adverse actions list every month, and CareOregon bars drivers who appear on the OIG list.
- Can an excluded person work in my office instead of driving?
- Not on work Medicaid pays for. OIG counts administrative and management services as covered by the exclusion even when they are never billed separately. Its guidance lists billing, accounting, staff training, and executive roles, unless the work is wholly unrelated to federal health care programs. For a company that lives on Medicaid trips, that leaves very little.
- A name came back as a possible match. What now?
- Confirm identity first. The downloadable file carries no Social Security or tax ID numbers, so use OIG's online search, which can check a match against an SSN or EIN. If the exclusion is confirmed, take the person off Medicaid work, identify the claims they touched, and get legal advice on repayment. OIG runs a Self-Disclosure Protocol for providers who find they already employed an excluded person, and Texas tells its providers to report any exclusion they find to HHS OIG right away.
- Does an exclusion end on its own when the term is over?
- No. Reinstatement is never automatic. The person applies to OIG no sooner than 90 days before the term ends and stays on the list until OIG approves the request. Receiving a provider number from a contractor or state program does not restore eligibility, so keep screening until the name is actually removed.
