Conviction: Patient Abuse or Neglect

Conviction: Patient Abuse or Neglect is a type of exclusion action taken by the HHS Office of Inspector General (OIG) under federal law. When a healthcare provider receives this exclusion, they are barred from participating in Medicare, Medicaid, and all other federal healthcare programs. There are currently 8,033 conviction: patient abuse or neglect exclusions across all U.S. states. Convicted of a criminal offense relating to neglect or abuse of patients in connection with the delivery of a health care item or service.

When a provider is excluded under the conviction: patient abuse or neglect category, no federal healthcare program will pay for any items or services furnished, ordered, or prescribed by the excluded individual or entity. Healthcare organizations that employ or contract with excluded providers may face civil monetary penalties of up to $100,000 per item or service. Exclusions also affect the provider's ability to work in most healthcare settings, even in non-billing roles, since organizations risk penalties for any involvement of excluded individuals in federally funded care.

To check if a specific provider has been excluded, search the OIG's List of Excluded Individuals/Entities (LEIE) database at oig.hhs.gov. You can search by name, specialty, or state. The database is updated monthly and includes all currently excluded providers. Healthcare organizations are required to check the LEIE before hiring and on a regular basis (typically monthly) to ensure no current employees or contractors are excluded. The System for Award Management (SAM) exclusion database also contains exclusion records.

Providers excluded under the conviction: patient abuse or neglect category may apply for reinstatement after the minimum exclusion period has elapsed. The minimum period varies by exclusion type — mandatory exclusions under Section 1128(a) of the Social Security Act typically carry a minimum 5-year period, while permissive exclusions under Section 1128(b) can vary. The provider must submit a written request to the OIG and demonstrate that the circumstances that led to exclusion have been resolved. Reinstatement is not automatic and requires OIG approval.