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Elizabeth M. Whitehorn, Director

Provider Notice issued 06/26/09

Terminated/Suspended Providers and Barred Entities and Individuals

To:​ All Participating Medical Assistance Program Providers​
Date:​ June 26, 2009​
Re:​ Terminated/Suspended Providers and Barred Entities and Individuals​

The purpose of this notice is to remind providers of their obligation to screen all employees and contractors to determine whether any of them have been terminated, suspended, or barred from participation in Federal or State healthcare programs.  There are two sanctions lists available to assist providers with this requirement.

  

The Department of Health and Human Services Office of Inspector General (HHS-OIG) maintains the List of Excluded Individuals/Entities (LEIE), a database that provides information about parties excluded from participation in Medicare, Medicaid, and all other Federal health care programs.  The LEIE Web site is located at: http://www.oig.hhs.gov/fraud/exclusions.asp

 

The Illinois Department of Healthcare and Family Services (HFS) Office of Inspector General (OIG) maintains a sanctions list that contains the names of providers and individuals who are currently terminated, suspended, barred, voluntarily withdrawn or otherwise excluded from participation in the Illinois Medical Assistance Program.  The site is located at: http://www.illinois.gov/hfs/oig/Pages/SanctionsList.aspx

 

Pursuant to 305 ILCS 5/12-4.25, the department has the authority to deny payment and/or impose sanctions on enrolled providers seeking reimbursement for services provided by an entity or individual on either sanctions list.  Specifically, no program payment will be made by the department for any items or services for which a sanctioned individual or entity serves as an employee, administrator, operator or in any other capacity related to the items or services on or after the date the individual or entity is shown to be ineligible on either Web site.

 

As a provider, you have an affirmative obligation to ensure you do not submit claims to the department for payment under the circumstances described above.  To ensure you do not submit such claims, the department expects you to check the sanctions list prior to employment or utilization of an individual or entity, and periodically thereafter.  Payments made for services provided by ineligible persons or entities may be recovered even though the service was provided and was otherwise completely legitimate.  In addition, your future participation in the Illinois Medical Assistance Program could be terminated or suspended.

 

If a person or entity you are considering using is on the sanctions list, the department recommends that you confirm eligibility with the OIG.  Inquiries must be in writing and submitted either by e-mail to hfs.oigwebmaster@illinois.gov or mailed to:

 

Healthcare and Family Services

Office of Inspector General

Administrative Services Unit

404 North Fifth Street

Springfield, Illinois 62702

 

In addition, providers may register to receive e-mail notification when the OIG provider sanctions list is updated. 

 

If you have any questions or need further information regarding this informational notice, or your obligations related to it, please feel free to contact the OIG’s Administrative Services Unit at 217-557-5996.

 

John C. Allen, IV, Inspector General

Office of Inspector General

 

Theresa A. Eagleson, Administrator

Division of Medical Programs