OIG is required by federal law to exclude any individuals and entities convicted of certain types of criminal offenses, such as Medicaid and Medicare fraud and any offenses related to the delivery of services under the aforementioned programs, SCHIP or various state health care programs. Other criminal offenses that would result in mandatory exclusion include patient abuse or neglect, theft, felony convictions of healthcare fraud, or felony convictions related to the unlawful manufacturing, prescription, distribution or dispensation of controlled substances.

OIG also is given discretionary abilities to exclude individuals and entities for a variety of other grounds. For example, exclusions could result in misdemeanor healthcare fraud convictions, fraud in any program funded by a government agency (state, local or federal), misdemeanor convictions related to controlled substances, provision of substandard or unnecessary services, suspension or revocation of healthcare licenses due to professional competence, participation in kickback schemes and Stark Law violations, defaulting on health education loans or violations of the False Claims Act.

In addition, just because an individual or entity receives a Notice of Intent to Exclude does not necessarily mean they will be excluded. The OIG will review all materials provided by the person receiving the Notice as part of its decision-making process, and all exclusions can be appealed.