What is the Texas OIG Exclusions Database?

Posted By Steve Alder on Dec 26, 2024

The Texas OIG exclusions database is a list of excluded individuals and entities similar to the federal HHS OIG exclusion database. The primary difference between the two databases is that the Texas OIG exclusions database contains the names of individuals and entities that have violated state law as well as those that have violated federal law.

Exclusion Databases Explained

Exclusion databases are lists of individuals and entities that are prohibited from providing goods or services to federal or state funded programs because they are guilty of some type of misconduct against the federal or state government. Most federal departments and state agencies maintain exclusion databases – usually through an Office of Inspector General (OIG) or equivalent.

The most well-known exclusion database in healthcare is the Department of Health and Human Services’ (HHS) OIG List of Excluded Individuals/Entities – also known as the OIG LEIE. This list contains the details of thousands of individuals and entities prohibited from providing goods or services to federal health care programs for violations of §1128 of the Social Security Act.

The reason this exclusion database is so well-known in healthcare is that healthcare providers who acquire goods or services from somebody on the database can be fined and potentially added to the database – effectively excluding themselves from federal health care programs. Consequently, all healthcare providers should frequently screen members of the workforce and vendors for exclusions.

What is the Texas OIG Exclusions Database?

The Texas OIG exclusions database is a list of individuals and entities who qualify for inclusion on the HHS OIG Exclusions List and who are also prohibited from providing goods or services in Texas because they have violated a state statute In Texas, this is most often a violation of a regulation promulgated by the Texas Board of Nursing, Texas Medical Board, or Texas State Board of Pharmacy.

Individuals and entities included in the Texas OIG exclusions database – that are not included in the HHS OIG Exclusions List – are not only excluded from receiving state funds, but also excluded from receiving federal funds for goods or services provided under Titles V (Maternal and Child Health Services), XIX (Medicaid), XX (Block Grants for Social Services), and/or other HHS programs.

However, unlike the HHS OIG Exclusions List, a healthcare provider in Texas can employ an individual on the Texas exclusions database or acquire goods from an excluded entity, provided that the costs associated with the employment of the individual or acquisition of goods are not claimed from a federal or state funded health care program.

Other Differences with the HHS OIG Database

Other than including violators of state laws, any other differences between the Texas OIG exclusions database and the HHS OIG exclusion database are attributable to communication gaps and inclusion processes. For example, all excluded entities on the HHS OIG database are automatically added to the Texas exclusions database, but the flow of information is not two-directional.

New additions to the Texas OIG exclusions database have to be notified to HHS OIG by the Texas Medicare Fraud Control Unit (MFCU) within 30 days. The same applies to all MFCUs in all states. However, notifications from other sources (i.e., law enforcement agencies, state licensing authorities, etc.) can take up to two years to appear on the HHS OIG database.

The reason for this is that there are two types of HHS OIG exclusions – “mandatory” and “permissive”. Violations that qualify for mandatory exclusion are automatically added to the OIG LEIE, but individuals and entities guilty of lesser violations can appeal the inclusion on the HHS OIG database – regardless of whether they are notified to HHS OIG by an MFCU or another source.

Best Practices for Healthcare Providers in Texas

Healthcare providers are advised to check both the Texas OIG exclusions database and HHS OIG exclusion database before employing new members of the workforce or entering into contracts with new suppliers. It may also be advisable to check suppliers’ workforces and any other providers with whom Protected Health Information may be shared against both databases.

The Texas HHS OIG also recommends that healthcare providers check the exclusions database monthly to screen existing members of the workforce and existing suppliers. This is not only due to potential delays between excluded individuals and entities appearing on either database, but also in case a supplier (for example) violates a state or federal law once contracted by a healthcare provider.

Healthcare providers in Texas unsure of their obligations to check exclusion databases should speak with a professional compliance advisor. A compliance advisor can explain what databases to check, what policies should be in place for workforce and supplier screening, and what the procedures are if a match is identified on either the HHS OIG Exclusions List of Texas OIG exclusions database.