How to Perform OIG Exclusion Screening: Step-by-Step Guide

Understanding OIG Exclusion Screening Requirements

The Office of Inspector General (OIG) maintains the List of Excluded Individuals and Entities (LEIE). This database protects federal healthcare programs from fraud, waste, and abuse. When the OIG excludes an individual or entity, they become ineligible to participate in any capacity in federal healthcare programs. These programs include Medicare, Medicaid, TRICARE, and other federally-funded health initiatives.

Federal law doesn't explicitly mandate that employers screen against the LEIE. However, the consequences of employing excluded individuals create a de facto requirement. The Centers for Medicare & Medicaid Services (CMS) has consistently held healthcare providers responsible for claims submitted involving excluded persons. This applies regardless of whether the employer knew about the exclusion.

This strict liability approach means that even unknowing violations can result in substantial financial penalties. Organizations also risk program exclusion for their entire operation.

Who Must Conduct OIG Exclusion Screening

Any organization that bills federal healthcare programs should implement OIG exclusion screening as a standard practice. The screening requirement extends beyond direct healthcare providers. It includes billing companies, consulting firms, and any vendor that influences or supports services reimbursed by federal programs.

Organizations requiring screening include:

• Hospitals and physician practices
• Nursing facilities and home health agencies
• Pharmacies and durable medical equipment suppliers
• Managed care organizations
• Healthcare staffing agencies and temporary placement services
• Medical billing companies and coding services

Healthcare staffing agencies bear particular responsibility for screening their workforce. They supply personnel to multiple healthcare facilities. Many healthcare organizations now include contractual language requiring their staffing partners to certify that all placed workers have been screened. This effectively transfers compliance responsibility to the agency.

Positions That Require Screening

OIG exclusion screening should encompass anyone who provides healthcare services, manages operations, or influences billing decisions within your organization. Administrative personnel who handle coding, billing, claims submission, or medical records also require screening. Their work has potential impact on reimbursement. The screening scope extends to contractors, vendors, board members, volunteers, and temporary staff.

Even individuals with indirect involvement in healthcare delivery may warrant screening. Examples include housekeeping staff in patient care areas or IT personnel with access to electronic health records. Your organization's risk tolerance and contractual obligations with payers will inform these decisions. When determining who needs screening, consider whether the individual's actions could potentially generate a claim to federal healthcare programs. Also assess whether they could compromise patient safety.

Legal Consequences of Non-Compliance

Employment of excluded individuals exposes healthcare organizations to civil monetary penalties. These fines can quickly escalate into millions of dollars. The OIG can impose penalties of up to $20,000 for each item or service furnished by an excluded person. Each individual claim is counted separately.

Beyond financial penalties, organizations that knowingly employ excluded individuals risk exclusion from federal healthcare programs themselves. This represents a "corporate death sentence" for most healthcare providers. The OIG may also require repayment of all claims involving the excluded individual. This lookback period extends to the exclusion effective date or when the employer should have reasonably discovered the exclusion.

State Medicaid programs often pursue parallel enforcement actions. This compounds the financial and operational consequences.

Accessing the OIG LEIE Database

The OIG provides free public access to the LEIE through its website at oig.hhs.gov. The database serves as the authoritative federal source for exclusion information. Updates occur regularly throughout each month as new exclusions are imposed. Existing exclusions may also be reinstated or modified.

To begin your search, navigate to the OIG's website and locate the "Exclusions" section. You'll typically find it under the "Fraud" menu. Alternatively, search for "LEIE" directly on the site. The OIG offers two primary search interfaces. The Online Searchable Database (LEIE) works for individual lookups. The Downloadable Database handles bulk screening operations.

Most organizations use the online interface for pre-employment screening of individual candidates. They use the downloadable version for monthly monitoring of existing workforce populations.

Navigating the LEIE Search Interface

The LEIE search interface provides multiple search fields to help you locate specific individuals or entities. However, relying solely on exact name matches can produce incomplete results. Spelling variations, name changes, hyphenations, and database entry inconsistencies create gaps. The Advanced Search feature allows you to search by additional identifiers. These include date of birth, Social Security Number (SSN), National Provider Identifier (NPI), Employer Identification Number (EIN), and address information.

You may not always have access to all these identifiers during pre-employment screening. However, obtaining and searching multiple data points significantly reduces the risk of false negatives. These situations occur where an excluded individual goes undetected due to name variations or data entry errors.

Understanding Search Results and Database Fields

When your search returns results, the LEIE displays key information. You'll see the excluded party's name, type (individual or entity), and specialty if applicable. The database also shows address, exclusion date, and reinstatement date if applicable.

The "Exclusion Type" field indicates the legal authority under which the exclusion was imposed. Common codes include 1128(a) for mandatory exclusions related to criminal convictions. Code 1128(b) indicates permissive exclusions based on various misconduct categories. The "Waiver" field indicates whether the individual has been granted a waiver or state exception. This allows limited participation in their home state's Medicaid program.

However, waivers are extremely rare and state-specific. Always consult with legal counsel before employing any individual appearing on the LEIE. This applies regardless of waiver status, as the risks typically outweigh potential benefits.

Conducting Comprehensive Pre-Employment Screening

Pre-employment OIG exclusion screening should occur after a conditional job offer has been made. Complete it before the candidate begins work or gains access to federal healthcare program information. This timing aligns with Fair Credit Reporting Act (FCRA) requirements if you're using a third-party screening service. Exclusion list checks may be considered consumer reports under certain circumstances. This applies when obtained through a consumer reporting agency.

Effective pre-employment screening extends beyond the federal LEIE. It includes state Medicaid exclusion lists and the System for Award Management (SAM) database. Many states maintain their own Medicaid exclusion lists. These may include individuals not appearing on the federal LEIE, particularly for state-specific violations or administrative actions.

Collecting Accurate Candidate Information

Gathering complete identifying information from candidates ensures accurate screening results. Inform candidates that exclusion screening will be conducted as part of the background check process. This is particularly important if you're using a third-party screening provider.

Essential information to collect:

• Full legal name: Include middle names and any former names or aliases
• Date of birth: Critical for distinguishing between individuals with similar names
• Social Security Number: Useful for verification but not always necessary for initial search
• Professional credentials: License numbers and NPI for healthcare professionals
• Previous addresses: Helps verify identity and distinguish similar names

Under the FCRA, specific requirements apply if exclusion screening is performed through a consumer reporting agency. You must provide appropriate disclosure and obtain written authorization before conducting the check. Organizations conducting their own in-house exclusion screening should still maintain transparency. Make screening practices part of your overall hiring process.

Performing Multiple Database Searches

Begin with the federal LEIE using the candidate's full name and date of birth. Search variations of the name. Include nicknames, middle names as first names, hyphenated names, and common misspellings. Next, check your state's Medicaid exclusion list. The state's Department of Health Services or Medicaid agency typically maintains this list.

Each state maintains its own list format and search interface. Familiarize yourself with your state's specific system. Then search the SAM.gov database using the same name variations. While SAM exclusions primarily affect federal contractors, comprehensive compliance programs include this check. It helps identify individuals with broader federal eligibility issues.

Documenting Pre-Employment Screening Results

Create a permanent record of every exclusion screening performed. Document the screening regardless of whether the search returns a match. If using the online LEIE, take screenshots showing the search parameters entered. Capture the "No Results Found" message or any positive matches returned.

Store this documentation in the candidate's employment file or your compliance records system. It should be readily accessible during audits. Retention periods for exclusion screening documentation typically align with employment records retention requirements. This is generally seven to ten years. However, organizations should consult with legal counsel regarding specific retention obligations in their jurisdiction.

Implementing Monthly Ongoing Monitoring

Monthly monitoring of current employees, contractors, vendors, and board members represents a critical compliance component. Many organizations overlook this requirement. The OIG adds new exclusions to the LEIE continuously throughout each month. This means an individual who cleared pre-employment screening could become excluded at any time.

Subsequent criminal convictions, civil settlements, license revocations, or other disqualifying actions can trigger exclusion. The OIG explicitly recommends monthly screening in its guidance materials. More frequent monitoring provides greater protection against liability exposure. Courts and regulators have recognized monthly monitoring as the industry standard. They evaluate whether an organization exercised reasonable diligence in preventing employment of excluded individuals.

Establishing a Monthly Monitoring System

Designate a specific individual or team responsible for conducting monthly exclusion screening. Establish a consistent schedule—such as the first business day of each month or the last business day of the previous month. Organizations with large workforces often use the downloadable LEIE database file for monthly monitoring. This approach is more efficient than conducting individual online searches for each person.

The downloadable file is available on the OIG website. It contains the complete LEIE in a structured data format. The file can be imported into spreadsheet software or specialized compliance tracking systems. By matching your employee roster against this file, you can efficiently screen hundreds or thousands of individuals simultaneously.

Using Automated Screening Solutions

Many healthcare organizations invest in automated exclusion screening software. These systems perform scheduled monthly checks and alert designated personnel when matches occur. They typically search multiple databases simultaneously. Databases include the federal LEIE, state Medicaid lists, and SAM. The systems maintain historical documentation, track screening compliance, and generate audit-ready reports.

Key features to evaluate in automated solutions:

• Database coverage: Searches federal LEIE, state lists, and SAM simultaneously
• Update frequency: How often the system refreshes exclusion data
• Match algorithms: Handles name variations and reduces false positives
• Alert mechanisms: Immediate notifications when new exclusions are identified
• Documentation capabilities: Automated timestamped records and audit trails
• Integration options: Connects with existing HR or credentialing systems

Automation significantly reduces administrative burden and minimizes human error. This is particularly beneficial for organizations with large or frequently changing workforces. However, even when using automated solutions, compliance personnel should understand the underlying screening process. Periodically verify that the system is functioning correctly.

Responding to New Exclusions

When monthly monitoring identifies a current employee or contractor on an exclusion list, immediate action is essential. First, verify the match by carefully comparing identifying information. Check date of birth, address, and professional credentials to ensure the database entry actually refers to your individual. False positives can occur when individuals share similar names.

If the match is confirmed, immediately remove the individual from any activities related to federal healthcare programs. This typically means suspending the individual from work pending further investigation. Most healthcare positions involve federal program participation in some capacity. Consult with legal counsel regarding appropriate next steps.

Options may include termination of employment or reassignment to a position that does not involve federal healthcare programs. In rare cases, appeals of the exclusion may be appropriate if the individual believes it was imposed in error.

Checking Additional Exclusion Databases

Comprehensive exclusion screening extends beyond the federal LEIE. It includes multiple databases that capture different types of exclusions and eligibility restrictions. State Medicaid programs maintain their own exclusion lists. These may include individuals not appearing on the federal LEIE due to state-specific violations. Pending federal exclusions or administrative actions taken solely at the state level may also appear.

The SAM database captures individuals excluded from federal contracting and procurement activities. These individuals may pose compliance risks even if not yet excluded from healthcare programs. A thorough screening program incorporates these supplementary databases into both pre-employment and monthly monitoring processes.

State Medicaid Exclusion Lists

Each state Medicaid program maintains its own exclusion list. However, the format, accessibility, and comprehensiveness vary significantly across states. Some states provide easily searchable online databases similar to the federal LEIE. Others publish static PDF lists that require manual searching. Visit your state Medicaid agency's website to locate the exclusion list. Familiarize yourself with the search process.

State Medicaid exclusions may occur independently of federal exclusions. This happens when individuals violate state-specific program integrity rules. It also occurs when they commit fraud against only the state Medicaid program. State licensing boards may impose administrative sanctions that result in exclusion. Healthcare organizations operating in multiple states must check the exclusion list for each state where they provide services or employ personnel.

System for Award Management (SAM)

The System for Award Management (SAM) is accessible at sam.gov. It serves as the federal government's repository of excluded parties. These individuals and entities are ineligible to receive federal contracts, grants, or other federal assistance. While SAM exclusions primarily target federal contractors, the database includes individuals and entities excluded for fraud, program abuse, and other misconduct. This misconduct may overlap with healthcare program violations.

To search SAM, navigate to sam.gov and select the "Search Records" option. Then choose "Exclusions" as the record type. Enter the individual's or entity's name to search for exclusions. SAM also provides an advanced search function. It allows searches by various identifiers.

Creating Documentation and Audit Trails

Comprehensive documentation of your exclusion screening program creates the audit trail necessary to demonstrate compliance efforts. This documentation matters to regulators, government auditors, accrediting bodies, and managed care organizations. Without adequate documentation, even diligent screening practices may fail to protect your organization during audits or investigations.

A complete documentation system should capture several key elements. Include written policies and procedures, individual screening results, and monthly monitoring reports. Add training records and remediation actions taken when positive matches occur. This documentation serves multiple purposes. It demonstrates good-faith compliance efforts and supports your organization's defense against penalties if an excluded individual is inadvertently employed. Documentation also helps meet contractual obligations with payers and facilitates management oversight of compliance operations.

Developing Written Policies and Procedures

Create a formal written policy that defines your organization's exclusion screening program requirements and procedures. Your procedure document should provide step-by-step instructions for conducting searches. Include database URLs, search field instructions, screenshot requirements, and documentation storage locations.

Essential policy elements:

• Scope: Who must be screened (employees, contractors, vendors, board members)
• Databases: Which exclusion lists will be checked
• Frequency: Pre-employment and monthly ongoing monitoring schedules
• Responsibility: Individual or department accountable for screening
• Match procedures: Steps for verifying and responding to positive matches
• Documentation: Record-keeping requirements and retention periods
• Escalation: Protocols for reporting compliance concerns

Well-documented procedures ensure consistency across different staff members conducting screening. They also facilitate training of new compliance personnel.

Maintaining Screening Records

Establish a systematic approach to organizing and storing exclusion screening documentation. Many organizations maintain both physical compliance files and electronic documentation systems. Electronic systems offer advantages for searchability, storage efficiency, and audit response speed.

For each screening instance, retain records showing the individual's name, date of birth, and databases searched. Include the search date, person who conducted the search, results obtained, and any follow-up actions required. Screenshots from database searches provide visual evidence of the search process and results. For monthly monitoring, maintain roster lists showing all individuals screened that month. Include the monitoring date and summary results indicating whether any matches were identified.

Building Compliance Reports

Generate regular compliance reports summarizing your screening program activities for management review and board oversight. Monthly reports might include the number of pre-employment screenings conducted and monthly monitoring completion status. Add any positive matches identified, remediation actions taken, and outstanding compliance concerns.

These reports demonstrate management engagement with compliance activities. They create additional documentation showing that your organization treats exclusion screening as a priority. During government audits or investigations, compliance reports help illustrate your organization's commitment to program integrity.

Managing Positive Matches and Remediation

Discovering that a candidate or current employee appears on an exclusion list requires careful, immediate action. You must comply with regulations while respecting individual rights and employment law obligations. The approach differs depending on whether the match occurs during pre-employment screening or monthly monitoring of a current employee.

False positives occur regularly in exclusion screening. These are situations where the database entry refers to a different person with a similar name. This is particularly common for individuals with common names. Thorough verification using additional identifiers helps distinguish between true matches and false positives before taking adverse employment action. Use date of birth, Social Security Number, professional license numbers, and addresses for verification.

Verifying Potential Matches

When a search returns results, carefully compare all available identifying information. Compare the database entry with the individual being screened. The exclusion record includes details such as address, specialty, and sometimes partial identifiers. These can help confirm or rule out a match.

Never assume a match based solely on name similarity. Wrongly terminating employment or withdrawing job offers based on false positive matches can expose your organization to discrimination claims. You also risk wrongful termination litigation and FCRA violation liability. Document your verification process thoroughly. Include what information was compared, any calls to the OIG hotline, and the conclusion reached. Note whether the exclusion applies to your individual.

Handling Pre-Employment Matches

If you confirm that a candidate is excluded, do not proceed with employment. You cannot hire excluded individuals in any capacity that involves federal healthcare programs. This applies even to positions that seem minimally connected to patient care or billing.

If you've already extended a conditional job offer, withdraw it based on the exclusion status. Organizations using consumer reporting agencies for exclusion screening must follow FCRA adverse action procedures. This includes providing pre-adverse action and adverse action notices. Include information about the candidate's dispute rights.

Responding to Employee Exclusions

When monthly monitoring reveals that a current employee has been excluded, immediate action is critical. This limits your organization's liability exposure. The individual must be immediately removed from any work involving federal healthcare programs. For most healthcare organizations, this effectively requires immediate suspension from all duties. Suspension should remain in effect pending investigation and final resolution.

Consult with legal counsel before terminating employment. Employment law considerations may affect termination procedures even though the individual's exclusion status creates an insurmountable compliance barrier to continued employment. Investigation should include determining the exclusion effective date. Calculate potential liability exposure from any services the individual provided after that date. Assess whether any claims should be voluntarily refunded to federal programs.

Building a Sustainable Compliance Program

Effective OIG exclusion screening requires more than technically correct database searches. It demands an organizational culture that prioritizes compliance and allocates appropriate resources. Provide ongoing training and continuously improve processes based on lessons learned and regulatory developments. A sustainable compliance program integrates exclusion screening into broader employment and credentialing workflows. Don't treat it as an isolated compliance task.

Leadership support and adequate resources form the foundation of sustainable compliance programs.

Training and Accountability

All personnel involved in hiring, credentialing, or compliance activities should receive training on exclusion screening requirements. Training should cover your organization's specific policies and procedures. Address why screening is necessary and which databases must be checked. Explain how to conduct searches properly. Cover documentation requirements and procedures for responding to potential matches.

Establish clear accountability for compliance tasks. Designate specific individuals or positions responsible for conducting pre-employment screening, monthly monitoring, documentation maintenance, and reporting. Regular audits of compliance activities help ensure that procedures are being followed consistently. For example, randomly select employee files to verify that screening documentation is present and complete. These audits also identify opportunities for improvement.

Periodic Program Assessment

Conduct periodic assessments of your exclusion screening program's effectiveness. Schedule these typically annually or when significant operational changes occur. Assessment should evaluate whether current procedures remain appropriate for your organization's size and complexity. Determine whether screening is being conducted consistently according to policy. Verify whether documentation is adequate for audit purposes.

Consider engaging external consultants or legal counsel to review your compliance program periodically. Outside experts can provide valuable perspectives on industry best practices, regulatory developments, and potential program improvements. These assessments create additional documentation demonstrating your organization's commitment to compliance.

Staying Current with Regulatory Changes

OIG exclusion screening requirements and best practices evolve over time. Regulations change, enforcement priorities shift, and new guidance is issued. Designate someone within your compliance team to monitor regulatory developments related to exclusion screening. Subscribe to OIG email updates, follow relevant professional associations, and monitor healthcare compliance publications.

When regulatory changes occur, promptly assess their impact on your screening program. Update policies, procedures, and training materials as needed. Document your review of regulatory changes and any program modifications implemented in response. This demonstrates ongoing compliance attention and adaptability to evolving requirements.

Conclusion

OIG exclusion screening represents a critical compliance obligation for healthcare organizations. It requires systematic processes, thorough documentation, and ongoing vigilance. By implementing the step-by-step procedures outlined in this guide, healthcare employers can effectively meet their regulatory responsibilities. These procedures range from accessing databases and conducting comprehensive searches to establishing monthly monitoring and managing positive matches. Remember that exclusion screening protects your organization from severe financial penalties. It also protects federal healthcare programs and beneficiaries from potentially dangerous or dishonest individuals, making it a fundamental component of healthcare integrity.

Frequently Asked Questions

How often should healthcare organizations screen employees against the OIG exclusion list?

Healthcare organizations should conduct OIG exclusion screening before hiring any employee, contractor, or vendor. Then perform monthly ongoing monitoring throughout the employment or business relationship. The OIG adds new exclusions continuously throughout each month. This means individuals who cleared initial screening can become excluded at any time. Monthly monitoring represents the industry standard and aligns with OIG recommendations.

What happens if we accidentally employ someone on the OIG exclusion list?

Accidentally employing an excluded individual exposes your organization to civil monetary penalties up to $20,000 per item or service. Each separate claim is counted individually. Upon discovering an excluded employee, immediately remove them from any work involving federal healthcare programs. Consult with legal counsel regarding notification obligations and potential liability exposure. You may need to identify and voluntarily refund payments received for services provided after the exclusion effective date.

Do we need to check both the federal OIG list and state Medicaid exclusion lists?

Yes, comprehensive compliance requires checking both federal and state exclusion lists. State Medicaid programs maintain their own exclusion lists. These may include individuals not appearing on the federal list due to state-specific violations, pending federal proceedings, or administrative actions taken solely at the state level. Organizations should check the exclusion list for each state where they operate or employ personnel.

Can we hire someone who appears on the OIG exclusion list for a non-clinical position?

Generally, organizations participating in federal healthcare programs should not employ excluded individuals in any capacity. This applies even to positions that seem minimally connected to patient care or billing. The OIG takes the position that exclusion prohibits any employment arrangement where the individual's compensation is paid in whole or in part by federal healthcare programs. Legal counsel should be consulted before considering employment of any excluded individual. The safest approach is universal exclusion from employment.

What information do we need from candidates to conduct proper exclusion screening?

At minimum, collect the candidate's full legal name, including middle names and any former names or aliases used. Also collect date of birth. Social Security Numbers are helpful for verification but not always necessary for the initial search. They become important if potential matches are identified. Professional license numbers and National Provider Identifiers (NPIs) provide additional verification points for licensed healthcare professionals.

How long should we retain exclusion screening documentation?

Healthcare organizations should retain exclusion screening documentation for at least seven to ten years. This aligns with general healthcare records retention requirements, though specific retention obligations may vary by state and organizational policies. Documentation should include evidence of pre-employment screening for all individuals hired. Include monthly monitoring reports showing all active employees were screened and any actions taken in response to positive matches. Organizations should consult legal counsel regarding specific retention requirements in their jurisdiction.

Are automated exclusion screening services worth the investment?

For organizations with more than approximately 50-100 employees or those experiencing frequent turnover, automated exclusion screening services typically provide excellent return on investment. Automated systems perform scheduled monthly monitoring without requiring manual staff effort. They search multiple databases simultaneously, generate alerts when matches are identified, and maintain historical documentation. Smaller organizations with stable workforces may effectively manage with manual screening using the free OIG database.

What should we do if an employee's name is similar to someone on the exclusion list?

When you encounter a potential match between an employee and an exclusion list entry, carefully verify whether the database record actually refers to your employee. Compare all available identifying information. If you have access to the employee's Social Security Number, you can contact the OIG's LEIE Hotline at 1-800-HHS-TIPS to request verification. Document your verification process thoroughly. Never take adverse employment action based solely on name similarity without thorough verification.

Additional Resources

1. Office of Inspector General - List of Excluded Individuals and Entities (LEIE)
   https://oig.hhs.gov/exclusions/
2. OIG Provider Self-Disclosure Protocol
   https://oig.hhs.gov/compliance/self-disclosure-info/
3. System for Award Management (SAM) Exclusions Database
   https://sam.gov/content/exclusions
4. CMS Medicare Exclusion Download
   https://www.cms.gov/medicare/provider-enrollment-and-certification/medicareprovidersupenroll
5. National Association of Professional Background Screeners - Healthcare Screening Guidelines
   https://www.napbs.com/