Peer Review Organization Recommendation
Open-data reference.
Excluded based on recommendation of a Peer Review Organization (PRO) / Quality Improvement Organization (QIO).
Recent Exclusions
| Name | State | Category | Date |
|---|---|---|---|
| BOBBY C MERKLE | AL | Physician | 2016-07-11 |
| EMIL T MARTINEZ | CA | Physician | 2008-07-03 |
| BRUCE STANTON HINKLEY | TX | Physician | 2001-11-14 |
| IVYL WILLIAM WELLS | ID | Physician | 2001-11-03 |
| JESSE M BROOKS | TX | Physician | 1998-06-09 |
| ALFRED L KLEIN | LA | Physician | 1997-02-20 |
| DEAN HOLT | UT | Physician | 1995-03-16 |
| WILLIAM A SPENCER | IA | Physician | 1994-11-15 |
| WILLIAM JAMES HANHAM | NC | Physician | 1994-02-23 |
| MILDRED J STEVENS | KS | Physician | 1993-12-29 |
| DONALD STOOPS | NM | OSTEOPATHY | 1993-09-14 |
| LAWRENCE VALIN | IA | Physician | 1993-06-23 |
| JAMES D BOWEN | OR | Physician | 1993-06-08 |
| SUNIL R LAHIRI | CA | Physician | 1992-09-02 |
| LOUIS W DEINNOCENTES | AL | Physician | 1992-04-20 |
Peer Review Organization Recommendation by State
Actual exclusion counts from HHS OIG LEIE database by state.
Source: HHS Office of Inspector General — List of Excluded Individuals/Entities (LEIE) HHS Office of Inspector General — List of Excluded Individuals/Entities (LEIE)
What the Peer Review Organization Recommendation Numbers Reveal
The peer review organization recommendation category currently accounts for 53 federal healthcare exclusions — roughly 0.4% of all active OIG LEIE entries. Exclusions under this category span 26 U.S. states, meaning licensing discipline in this specific action type is not concentrated in a single jurisdiction. Texas records the highest concentration with 8 excluded providers, while California follows with 4. Because this data comes directly from the HHS Office of Inspector General's monthly LEIE file, every entry reflects a formal federal debarment — not a pending allegation.
Excluded based on recommendation of a Peer Review Organization (PRO) / Quality Improvement Organization (QIO). Patterns like this matter because healthcare organizations are legally required to screen employees, contractors, and referring providers against the LEIE before hiring and on an ongoing basis. A single billing interaction involving an excluded provider under the peer review organization recommendation category can trigger civil monetary penalties of up to $100,000 per item or service furnished, plus treble damages. The 53 individuals and entities currently flagged represent an active compliance exposure for every hospital, clinic, pharmacy, and insurer operating in the affected states.
For patients and families, the state-by-state breakdown above is a starting point for verification — not a substitute for it. Exclusion status can change monthly as providers are added, reinstated, or moved between action categories. Before choosing a provider, always cross-check the current OIG LEIE at oig.hhs.gov and the relevant state medical board's public license verification tool. Because peer review organization recommendation exclusions carry federal weight, they typically persist across state lines even if a provider relocates, making the LEIE the single most official source for confirming eligibility to receive Medicare, Medicaid, or TRICARE payments.
Frequently Asked Questions
What is a peer review organization recommendation exclusion?
Peer Review Organization Recommendation 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 53 peer review organization recommendation exclusions across all U.S. states. Excluded based on recommendation of a Peer Review Organization (PRO) / Quality Improvement Organization (QIO).
What is the impact on healthcare providers?
When a provider is excluded under the peer review organization recommendation 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.
How can I check if a provider is excluded?
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.
Can a provider be reinstated after exclusion?
Providers excluded under the peer review organization recommendation 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.
Patient Resources
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Disclaimer: This information is provided for informational purposes only and does not constitute professional advice. Data is sourced from the HHS Office of Inspector General (OIG) and BLS. Consult a qualified professional before making decisions based on this data.
Read our methodology — how this data is sourced, computed, and verified.
All federal data sources used on this page
- U.S. Census Bureau ACS — demographic + housing + income data. census.gov/programs-surveys/acs
- BLS Occupational Employment and Wage Statistics (OEWS) — wage + employment by occupation. bls.gov/oes
- BEA Regional Economic Accounts — GDP + personal income by state/metro. bea.gov/data/regional
- U.S. Census Bureau County Business Patterns — establishment + employment by industry. census.gov/cbp
- IRS Statistics of Income (SOI) — tax-return aggregate data. irs.gov/statistics
- data.gov — U.S. federal open-data portal — discovery layer for additional federal sources. data.gov