Most agencies run an exclusion search when they hire someone. Fewer run it again the next month, or on the billing contractor, or on the staffing agency nurse who covered three weekends. Then an auditor asks for screening evidence for one employee across the last two years, and the folder has a single printout from the hiring date.
An OIG exclusion check is a five-minute task per month for a small roster and a small batch job for a large one. This guide explains why monthly is the frequency agencies settle on, which lists to search, how to verify a potential match, what to keep as proof, and what to do if someone turns up excluded.
What an Exclusion Actually Does
Under 42 CFR 1001.1901, no payment is made by Medicare, including Medicare Advantage, Medicaid or any other federal health care program for any item or service furnished by an excluded individual or entity on or after the effective date of the exclusion. The regulation also names administrative and management services and salary among the things that can draw consequences.
OIG's Special Advisory Bulletin on the Effect of Exclusion, published May 8, 2013, spells out the practical reach. The payment prohibition covers administrative and management services payable by federal programs even when those services are not separately billable. An excluded scheduler, biller or office manager can taint claims just as an excluded aide can.
Why a Monthly OIG Exclusion Check Is the Standard
The bulletin states that providers are not required by statute or regulation to check the List of Excluded Individuals/Entities (LEIE). It then recommends that screening employees and contractors each month best minimizes potential overpayment and civil monetary penalty liability.
Three facts make monthly the natural cadence:
- The list changes monthly. OIG's exclusions page says the LEIE is updated monthly, and its FAQ says both versions are generally updated by the middle of each month.
- States check monthly. Under 42 CFR 455.436, state Medicaid agencies must check the LEIE and the Excluded Parties List System (now part of SAM.gov) no less frequently than monthly. Check whether your state's provider agreement or Medicaid rules pass a similar expectation on to you.
- Exposure accumulates by claim. Every month an excluded person keeps working adds claims to the amount at risk.
Which Lists to Search
- OIG LEIE. The core federal health care exclusion list. Use the online searchable database for individual checks and verification, and the downloadable file for batch matching.
- SAM.gov exclusions. OIG's FAQ notes that GSA administers SAM.gov, which contains debarment actions taken by many federal agencies, including OIG exclusion actions. It catches debarments that are not on the LEIE.
- Your state Medicaid exclusion or termination list, if your state publishes one. Requirements and list names vary by state, so confirm with your state Medicaid agency.
- Licensing boards and registries for license status. These are credential checks rather than exclusion checks, but they belong in the same monthly routine.
Who to screen is broader than "employees." The bulletin recommends reviewing each job category and contractual relationship, including contractors, subcontractors and the employees of contractors, using the same analysis. Practically, that means owners and managing employees, every W-2 employee, 1099 clinicians, staffing agency personnel, billing companies and any vendor whose staff touch federally reimbursed work.
A Monthly Screening Procedure
- 1.Keep a clean roster. Legal name, prior and alternate names, date of birth, NPI where applicable, and the last four digits of the Social Security number stored securely for verification. Most false negatives come from name changes.
- 2.Schedule the run after the monthly update. Pick a fixed day in the third week so every run covers the newest LEIE release.
- 3.Batch-match the roster against the downloadable LEIE and SAM.gov exclusions.
- 4.Verify every potential match in the online database. The FAQ explains that the online search can confirm an individual match using the Social Security number and an entity match using the EIN. The downloadable file does not contain either, so it cannot confirm a match.
- 5.Clear or escalate within one business day. A cleared false positive gets a note saying why. A confirmed match goes straight to the compliance officer.
- 6.Screen before the first shift for new hires and before the first claim for new contractors, then fold them into the monthly run.
What to Keep as Proof
The bulletin recommends keeping documentation of the search performed, such as a printed screenshot showing the results. Build a log that answers an auditor's questions without anyone needing to remember anything:
- Date of the run and the LEIE release it covered
- Lists searched
- Number of names screened
- Potential matches and how each was resolved, with the verification result
- Name of the person who ran it and the person who reviewed it
- Saved results, as a file or screenshot, for every run
Keep the log by month and keep each person's screening history retrievable by name. The question you will be asked is "show me every check for this aide since she started," not "show me March."
Sizing the Risk: A Worked Example
The figures below are illustrative assumptions, not data from any case.
An aide was excluded six months after you hired her. You screened at hire and never again. She worked another 14 months before an auditor found the exclusion. She averaged 25 visits a month, every one billed to Medicaid or Medicare.
- Months worked while excluded: 14
- Visits furnished: 14 × 25 = 350
- Every one of those visits is an item or service furnished by an excluded individual, so the payments for them are at risk, before any penalty is calculated.
Now run the same scenario with monthly screening. Assume the exclusion shows up in the next monthly LEIE release. Your next run catches it, and the exposure shrinks to roughly one or two months: about 25 to 50 visits. The difference between 350 visits and 50 is the entire argument for monthly checks, and the screening itself takes minutes.
One more detail from OIG's FAQ: individuals and entities that are reinstated are removed from the LEIE. A name that disappears from the list has not necessarily been cleared for the past. Your log of what the list showed on each date is the record that matters.
When You Find a Match
Confirmed exclusions are a legal matter. The steps below are the usual order, but involve counsel at step one.
- 1.Remove the person from all federally reimbursed work immediately, including administrative work.
- 2.Establish the exclusion's effective date and when the person started working for you.
- 3.Identify affected claims in that window: direct services and services the person supported.
- 4.Consider OIG's Provider Self-Disclosure Protocol. The bulletin points providers to it for disclosing and resolving potential penalty liability.
The money is significant. The 2013 bulletin describes penalties of up to $10,000 for each item or service and an assessment of up to three times the amount claimed. Those amounts are adjusted for inflation every year: the HHS penalty table at 45 CFR 102.3 lists a 2025 maximum adjusted penalty of $25,595 for employing or contracting with an excluded individual.
Where Screening Programs Break
- Hire-only screening. Someone excluded after hire stays invisible.
- Contractors left out. The staffing agency says it screens, but nobody has seen its evidence. Ask for monthly attestations and spot-check them.
- Name changes. A caregiver who married or took a different legal name is screened under the old name forever.
- Matches cleared by eye. A common name is cleared because "it's obviously not her," without the SSN verification.
- Checks with no record. Screening that happened but was not logged is, for audit purposes, screening that did not happen.
Making It Routine
Exclusion screening is one of the few compliance tasks that is fully knowable, fully schedulable and cheap. The compliance software guide explains why software should organize this work while people make the decisions. Nuraflow is being designed so that background and exclusion screening records consent, initiates the exclusion checks an agency configures and tracks each required recheck, with results tied to the same employee file that credentials and scheduling gates read before an assignment.
This article is general information, not legal advice. Confirm your screening obligations, including state Medicaid requirements, with counsel and your state Medicaid agency.