Save Time & Money and Take the Stress out of Exclusions Screening
- Make your life easier and save hours on manual exclusion checks!
- Maintain compliance with federally funded healthcare programs.
- Prevents potential Civil Monetary Penalties.
- Continuous Monitoring OIG Exclusions, SAM, & all State Medicare Exclusions Lists updated monthly.
- Comprehensive and audit-ready Exclusions Report.
Non-compliance can be severe!
- Required repayment of claims.
- Costly Civil Monetary Penalties.
- Loss of access to federally funded healthcare programs.
$89.00/month — Cancel anytime.
Why It Matters
Monthly screening of new hires, existing employees, and contractors for OIG Exclusions, SAM Exclusions, and all State Medicaid Exclusion Lists is a compliance requirement for many healthcare organizations.
Providers excluded by the OIG or terminated by a State Medicaid Agency cannot participate in federally funded healthcare programs. This includes Medicaid, TRICARE, and the Children’s Health Insurance Program (CHIP). Additionally, the Centers for Medicare & Medicaid Services (CMS) can revoke billing privileges, prohibiting the provider from participating in Medicare.
Providers are liable for overpayments made for any items or services provided by any excluded person for which the provider received reimbursement from federal healthcare programs. Additionally, the provider may face Civil Monetary Penalties (CMP) if they fail to ensure that proper exclusion screening has been conducted.
Benefits of Automated Continuous Exclusion Monitoring
- Make your life easier and save hours on manual exclusion checks!
- Maintain compliance with federally funded healthcare programs.
- Prevent potential costly Civil Monetary Penalties.
Features
- Manage your list of all healthcare providers, employees, vendors, and contractors that are continually being monitored.
- Monthly OIG Exclusions, SAM Exclusions, & all State Medicare Exclusions Lists updates.
- Comprehensive and audit-ready Exclusions Report.
- Automatic Exclusions Change Notifications.
- Detailed Exclusions Dashboard with total Providers, Exclusions, Verifications, Reinstatements, Medicare Out-of, and NPI deactivations.
- Primary Source Exclusion Verification Tools.
- The ability to Save Notes & Documented Evidence of Exclusion Screening.
Screen OIG Exclusions, SAM, and all State Medicare Exclusions Lists all at Once
Our automated continual exclusions monitoring checks providers against all major Federal & State exclusion databases, including:
- OIG Exclusions List of Excluded Individuals and Entities (LEIE)
- All State Medicaid Termination Lists
- SAM Debarments (SAM.gov)
- FDA Debarments
- FDA Clinical Investigator—Disqualification Proceedings
- CMS Medicare Opt-out Affidavits
- NPI Deactivation List
Comprehensive Exclusions Report
The Exclusions Report can be downloaded from the Exclusions Dashboard anytime, and it includes:
- Full Name, First, Middle, and Last Names.
- Full Address, Address 1, Address 2, City, State, Zip.
- NPI Number and NPI Deactivated Date.
- License Numbers.
- Medicare Opt Out Affidavit Start and End Dates.
- Exclusion Date, Reason, and Reinstatement Date.
- Exclusion Status of Clear, Exact, Possible, Reinstated, Deactivated, Opted-out.
- OIG, SAM, or State reporting Agency Details.
- Links to the Exclusion Source Data and Verification Page.
- All saved exclusion screening notes and documented evidence.
Frequently Asked Questions
Requirement
Federal database checks—42 CFR Part § 455.436 requires all Medicare Advantage Plans, all State Medicaid Programs, and all Medicaid Managed Care Organizations to confirm through routine Federal database checks the exclusion status of providers.
Compliance
The Office of Inspector General (OIG) mandates screening to prevent fraud, abuse, and patient neglect.
Financial Risk
Hiring an excluded individual can result in substantial Civil Monetary Penalties (CMPs) and repayment obligations.
According to the OIG’s Special Advisory Bulletin issued in May 2013, the OIG recommends that healthcare organizations check their employees and contractors against the LEIE monthly.
42 CFR Part § 455.436(c)(2) Federal database checks states to “check the LEIE and SAM no less frequently than monthly.”
Monthly screening is mandatory in at least 14 States, while many others strongly recommend that providers screen employees and vendors against their State lists and the LEIE monthly.
Healthcare organizations must conduct exclusion screening for all individuals and entities that provide items or services payable by federal health care programs.
This requirement applies to anyone whose work supports services reimbursed by Medicare or Medicaid—whether those services are provided directly or indirectly.
Healthcare Providers & Facilities
Hospitals, nursing homes, home health agencies, clinics, and physician practices.
Personnel
All employees (clinical and non-clinical), pharmacists, pharmacy staff, physicians, nurses, clinical staff, medical assistants, and administrative staff.
Contractors & Vendors
Third-party billing & coding services, transportation providers, ambulance services, and medical equipment suppliers.
Leadership & Support
Board members, managers, owners, and volunteers.
Basically, if an individual’s role contributes in any way to federally reimbursable services, that individual should be included in your OIG exclusion screening and Medicare exclusion monitoring process.
Furthermore, the OIG has emphasized that civil monetary penalties are most likely when excluded individuals provide essential services to patient care.
Learn more about who needs to be screened for Medicare Exclusion.