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Table 3 Fraud related LEIE rules [69]

From: Medicare fraud detection using neural networks

Social Security Act

Description

Minimum exclusion period

1128(a)(1)

Conviction of program-related crimes

5 years

1128(a)(2)

Conviction relating to patient abuse or neglect

5 years

1128(a)(3)

Felony conviction relating to health care fraud

5 years

1128(b)(4)

License revocation, suspension, or surrender

State dependent

1128(b)(7)

Fraud, kickbacks, and other prohibited activities

None

1128(c)(3)(G)(i)

Conviction of second mandatory exclusion offenses

10 years

1128(c)(3)(g)(ii)

Conviction of third mandatory exclusion offenses

Permanent exclusion