Exclusion Screening

Federal law prohibits Medicare payment from being made for items or services furnished or prescribed by an excluded provider or entity. CareFirst cannot use federal funds to pay for services, equipment or drugs prescribed or provided by a provider, supplier, employee or FDR excluded by the Department of Health and Human Services (DHHS) Office of the Inspector General (OIG) or General Services Administration (GSA). CareFirst and its FDRs must screen all employees and contractors who either provide or assist with administrative and/or healthcare or prescription drug services for CareFirst Medicare plans against OIG’s List of Excluded Individuals/Entities (LEIE) and the GSA Excluded Parties List system (EPLS) and System for Award Management (SAM) to ensure they have not been excluded.

FDRs must review the OIG LEIE and GSA EPLS/SAM systems for excluded individuals, at the time of hire/contracting and every month thereafter. Review for current employees/contractors, healthcare professionals or vendors that work on Medicare Advantage or Part D programs to ensure that none are excluded from participating in Federal healthcare programs.

For more information or access to the publicly accessible online databases, please see the following links:

• OIG Exclusions Program
• GSA Exclusion List