{
  "study": {
    "slug": "oig-exclusion-patterns",
    "title": "The OIG exclusion list, explained: who gets barred from Medicare, and why",
    "standfirst": "The OIG List of Excluded Individuals and Entities (LEIE) holds 68,055 active exclusions spanning 1977–2026. The most common reason to be barred from Medicare is not fraud — it is losing a state license: §1128(b)(4) license actions are 41% of the list. And only 10.3% of records carry an NPI, so the list is mostly non-clinicians.",
    "desk": "financial-distress",
    "article_type": "Original Research",
    "published": "2026-06-11",
    "issue": 53,
    "doi": "10.5072/fonteum/oig-exclusion-patterns-2026",
    "url": "https://fonteum.com/research/oig-exclusion-patterns",
    "methodology_version": "oig-leie-patterns/v1"
  },
  "data_as_of": "2026-05-08",
  "datasets": [
    {
      "slug": "oig-leie",
      "name": "OIG LEIE",
      "publisher": "HHS OIG — List of Excluded Individuals/Entities",
      "upstream_url": null
    }
  ],
  "key_findings": [
    {
      "number": "68,055",
      "finding": "active exclusion records on the OIG LEIE, spanning 1977 to 2026 — a 49-year accumulation, not a recent surge",
      "dataset": "oig-leie"
    },
    {
      "number": "41%",
      "finding": "of exclusions are §1128(b)(4) license revocations or surrenders (27,907 records) — the single largest category, larger than every fraud-conviction basis combined",
      "dataset": "oig-leie"
    },
    {
      "number": "10.3%",
      "finding": "of records carry a matching NPI (7,025 of 68,055) — the list is mostly non-credentialed billers, suppliers, and aides, not physicians",
      "dataset": "oig-leie"
    },
    {
      "number": "71%",
      "finding": "of all exclusions fall under just two bases — license actions (§1128(b)(4)) and program-related convictions (§1128(a)(1))",
      "dataset": "oig-leie"
    }
  ],
  "faqs": [
    {
      "q": "What is the OIG exclusion list (LEIE)?",
      "a": "The List of Excluded Individuals and Entities is the HHS Office of Inspector General's authoritative registry of people and organizations barred from federal health programs. No federal money may pay for any item or service an excluded party furnishes, directly or indirectly. The OIG updates it monthly."
    },
    {
      "q": "Why are most people excluded — fraud or something else?",
      "a": "Something else. License revocation under §1128(b)(4) is the single largest basis at 41% of records (27,907). Program-related fraud convictions under §1128(a)(1) are second at 30%. The popular picture of a fraud registry is wrong: the most common path onto the list runs through a state licensing board."
    },
    {
      "q": "What is the difference between mandatory and permissive exclusion?",
      "a": "Mandatory exclusions under §1128(a) follow convictions for program crimes, patient abuse, felony health fraud, or felony drug offenses, and carry a five-year minimum. Permissive exclusions under §1128(b) are discretionary — license actions, kickbacks, misdemeanors, defaulted health-education loans — with periods set case by case."
    },
    {
      "q": "Why do only 10.3% of records have an NPI?",
      "a": "Because the list is not physician-only. It covers anyone who participates in a federal health program — billing agents, equipment suppliers, home-health aides, pharmacy technicians, owners. Most never held a National Provider Identifier, so screening compliance against NPI alone misses roughly nine in ten excluded parties."
    },
    {
      "q": "Does an exclusion end automatically when the term is up?",
      "a": "No. Reinstatement is never automatic. An excluded party must apply to the OIG and receive written notice that reinstatement was granted before billing federal programs again. Obtaining a new Medicare provider number does not restore eligibility, and the party stays on the list until the OIG acts."
    },
    {
      "q": "Can I reproduce these numbers?",
      "a": "Yes. Every figure is a direct count over the 68,055-record oig_leie_exclusions table from the 2026-05-08 OIG release. The exact SQL is published in the reproducibility block below and on the OIG LEIE dataset page. Each count resolves to specific rows in a specific frozen federal snapshot."
    }
  ],
  "citation": {
    "apa": "Fonteum Research. (2026, June 11). The OIG exclusion list, explained: who gets barred from Medicare, and why. Fonteum Research, Issue 53. https://doi.org/10.5072/fonteum/oig-exclusion-patterns-2026",
    "url": "https://fonteum.com/research/oig-exclusion-patterns"
  },
  "reproducible_sql": "-- OIG Exclusion Patterns — fully reproducible query.\n--\n-- Source:   OIG List of Excluded Individuals and Entities (LEIE), monthly bulk download.\n-- Snapshot: oig-leie / release 2026-05-08 (ingested 2026-05-25), 68,055 active records.\n-- Table:    public.oig_leie_exclusions (public, read-only).\n-- Authority: Social Security Act § 1128 / 42 U.S.C. § 1320a-7.\n--\n-- Every headline figure in the study resolves to one of the rows below.\nWITH totals AS (\n  SELECT\n    count(*)                                                      AS total_records,\n    count(*) FILTER (WHERE npi IS NOT NULL AND npi <> '')         AS npi_present,\n    min(excl_date)                                               AS first_exclusion,\n    max(excl_date)                                               AS latest_exclusion\n  FROM public.oig_leie_exclusions\n)\nSELECT\n  t.total_records,                                                          -- 68,055\n  t.npi_present,                                                            -- 7,025\n  round(100.0 * t.npi_present / t.total_records, 1)        AS npi_match_pct, -- 10.3%\n  t.first_exclusion,                                                        -- 1977-07-01\n  t.latest_exclusion                                                       -- 2026-05-20\nFROM totals t;\n\n-- Statutory-authority breakdown (top bases by volume):\nSELECT\n  trim(exclusion_type)                                       AS statutory_basis,\n  count(*)                                                   AS records,\n  round(100.0 * count(*) / sum(count(*)) OVER (), 2)         AS pct\nFROM public.oig_leie_exclusions\nGROUP BY trim(exclusion_type)\nORDER BY records DESC\nLIMIT 8;\n--  1128b4   27,907  41.01   license revocation / surrender\n--  1128a1   20,579  30.24   program-related conviction\n--  1128a2    6,795   9.98   patient abuse / neglect\n--  1128a3    4,792   7.04   felony health-care fraud\n--  1128a4    2,960   4.35   felony controlled substance\n--  1128b14   1,824   2.68   default on health-education loan\n--  ...                       (b4 + a1 = 71.25% of the list)\n\n-- State concentration (top 5):\nSELECT\n  trim(state)                                               AS state,\n  count(*)                                                  AS records,\n  round(100.0 * count(*) / sum(count(*)) OVER (), 1)        AS pct\nFROM public.oig_leie_exclusions\nGROUP BY trim(state)\nORDER BY records DESC\nLIMIT 5;\n--  CA  7,896  11.6\n--  FL  6,816  10.0\n--  TX  4,816   7.1\n--  NY  3,538   5.2\n--  OH  3,166   4.7",
  "license": "U.S. Government Works (federal sources; 17 U.S.C. §105)",
  "generated_by": "Fonteum — https://fonteum.com",
  "notes": "Aggregate, source-traced figures frozen to the snapshot above. Reproduce by running reproducible_sql against the cited federal dataset; no per-entity records are included."
}