Check every employee, contractor and vendor whose work is paid for directly or indirectly by Medicare, Medicaid or another federal health program against OIG’s List of Excluded Individuals and Entities (LEIE) before you hire them and every month after. Search by name, not just NPI, confirm any possible match with a Social Security number on OIG’s site, and keep a dated record of every check.
Run a free check now, or look up an NPI with the exclusion check built in.
What exclusion means
The HHS Office of Inspector General can bar people and businesses from federal health care programs after certain convictions, license actions and other conduct. Once someone is excluded, Medicare, Medicaid and other federal health programs will not pay for any item or service that person furnishes, orders or prescribes. OIG publishes everyone currently excluded in the LEIE and updates it by the 10th of each month.
The payment ban follows the person, not the job title. OIG’s 2013 Special Advisory Bulletin, still its main guidance on the subject, makes clear that it reaches far beyond doctors and nurses. If an excluded person’s work is part of what a federal program pays for, even indirectly, that payment is not allowed.
Who you must screen
OIG’s test is whether the work is directly or indirectly payable by a federal health program. For most practices that bill Medicare or Medicaid, that covers almost everyone.
| Group | Examples | Screen? |
|---|---|---|
| Licensed clinicians | Physicians, nurse practitioners, physician assistants, therapists, nurses | Yes |
| Clinical support | Medical assistants, aides, technicians, pharmacy staff | Yes |
| Administrative staff | Front desk, billing, coding, scheduling, HR | Yes |
| Leadership | Practice manager, CFO, owners who manage operations | Yes |
| Contracted and agency staff | Locum tenens, agency nurses, outsourced billing staff | Yes, or verify the agency’s screening |
| Vendors and suppliers | Billing companies, labs, equipment suppliers, IT vendors with billing roles | Yes, the business and key people |
| Volunteers and students | Anyone doing work tied to federally paid services | Yes |
| Referring and ordering providers | Outside clinicians whose orders you bill on | Recommended |
What a missed exclusion costs
The money comes from three directions at once:
- Repayment. Federal programs can recover everything paid for items and services the excluded person furnished, ordered or prescribed. Overpayments must be reported and returned within 60 days of being identified.
- Civil money penalties. Under 42 U.S.C. § 1320a-7a, a provider that employs or contracts with someone it knew or should have known was excluded faces up to $20,000 per item or service in the statute, $25,595 after the latest inflation adjustment, plus up to three times the amount claimed.
- Exclusion of the practice itself. OIG may also exclude the employer, which ends its ability to bill federal programs.
Sources: 42 U.S.C. § 1320a-7a (civil monetary penalties); HHS inflation adjustment, January 2026; 42 U.S.C. § 1320a-7k(d).
2026 settlements
OIG publishes its civil money penalty settlements. These five from 2026 were all for allegedly employing someone the provider knew or should have known was excluded. Every one of them self-disclosed to OIG, and each still paid. The settlements resolve allegations; they are not findings of liability. None are Wellformed AI clients.
| Provider | Date | Paid | Role named |
|---|---|---|---|
| Liberty County Hospital District No. 1 and PF Carthage SNF Ops | Aug 24, 2026 | $525,882.88 | Not stated |
| Advanced Health Care of Colorado Springs | Jul 20, 2026 | $500,019.53 | Medication and treatment nurse (RN/LPN) |
| Dialysis Care Center | Aug 24, 2026 | $254,530.09 | Not stated |
| Barnet Dulaney Perkins Eye Center | May 8, 2026 | $175,513.11 | Not stated |
| Cookeville Regional Medical Center | Jun 26, 2026 | $20,000.00 | Not stated |
Who is on the list
These charts are drawn from OIG’s current monthly file, the same data our free check uses, and they update when OIG publishes each new list.
In OIG’s October 2026 file, the most common ground for exclusion was license revocation, suspension or surrender (33,455 entries), and 43,838 of the 84,093 exclusions were mandatory. OIG’s “Nursing profession” category alone held 12,576 entries and “Employee, private sector” 5,421, against 3,277 in “Physician (MD, DO)”. Screening only your doctors misses most of the list. So does screening by NPI: most entries have none, and name searches are the only way to catch them.
Mandatory and permissive exclusions
OIG excludes under two kinds of authority in section 1128 of the Social Security Act. The difference matters when you read a match, because it tells you why the person was excluded and how long it lasts at a minimum.
| Type | Common grounds | Minimum length |
|---|---|---|
| Mandatory | Conviction of a program-related crime, patient abuse or neglect, felony health care fraud, felony controlled-substance conviction | 5 years; 10 years for a second offense; permanent for a third |
| Permissive | License revocation or surrender, misdemeanor fraud, exclusion by another program, kickbacks, defaulting on health education loans, and others | Varies: from no minimum to the period set by the licensing board or program |
Our exclusion check shows the plain-English meaning of the authority on every match. Source: HHS OIG, Background Information and Exclusion Authorities.
How often to screen
No statute or regulation tells a private practice how often to check. OIG’s bulletin recommends checking before you hire or contract with someone and periodically after, and says screening every month “best minimizes” the risk of overpayments and penalties, because the list itself changes monthly.
Medicaid sets a firmer example. Federal rules require state Medicaid agencies to check the LEIE and the federal exclusion system in SAM at least monthly for the providers they enroll, and many states pass that expectation on to providers through their agreements. Source: 42 CFR § 455.436.
The lists that matter
| List | Run by | What it covers | How to confirm a match |
|---|---|---|---|
| LEIE | HHS OIG | Exclusions from federal health care programs | SSN or EIN on OIG’s online search |
| SAM.gov exclusions | US General Services Administration | Debarments and exclusions across federal agencies, including some health program exclusions | Record details on SAM.gov |
| State Medicaid exclusion lists | Each state Medicaid program | People and businesses barred from that state’s Medicaid program, which may not be on the LEIE | Varies by state |
| State licensing boards | Each state board | License status, discipline and restrictions | The board’s own lookup |
| NPI Registry | CMS | Provider identity and NPI status, self-reported | NPI number |
A screening process that holds up
- Keep a roster. Every employee, contractor, volunteer and vendor, with legal name, any former names, date of birth, NPI if any, and start date.
- Collect identifiers securely. You will need a Social Security number (or a business’s EIN) only to confirm a possible match on OIG’s site. Store it with your HR records, not in screening spreadsheets.
- Screen before day one. Check new hires and new vendors before they start any federally reimbursed work.
- Search by name, then NPI. Name searches catch the 89% of entries without an NPI. Search former names and business names too.
- Repeat monthly. After OIG publishes the new list, check everyone on the roster again.
- Save dated proof. Print or save each result as a PDF showing who was checked, which list month and the result.
- Put it in contracts. Require vendors and staffing agencies to screen their people and share records on request.
How to read an LEIE entry
OIG publishes the list in two forms: an online search, and a downloadable file that tools like ours use. The downloadable file has one row per excluded person or business with these fields, and knowing them makes a possible match much faster to judge:
| Field | What it tells you | How to use it |
|---|---|---|
| Last, first and middle name | The individual’s name as OIG recorded it | Compare with legal and former names on your roster |
| Business name | Filled in for excluded entities | Search vendors and the businesses your staff own |
| General and specialty | OIG’s category and the person’s field, such as nursing or a business type | Does it fit the person you hired? |
| NPI | Present on only a minority of entries | An NPI match is strong evidence; no NPI proves nothing |
| Date of birth | Included for many individuals | A quick way to rule a match in or out |
| Address, city and state | The address at the time of exclusion | Older entries may show an old address |
| Exclusion type | The section of the Social Security Act used | Tells you why and whether it was mandatory |
| Exclusion date | When the exclusion took effect | Claims after this date are the ones at risk |
| Waiver date and state | A narrow waiver, if one was granted | Covers only the state or program named |
The file does not include Social Security numbers or EINs. That is deliberate: it lets anyone screen without exposing identity numbers, and it is why OIG asks you to confirm a possible match by entering the SSN or EIN on its own online search, which checks it against the full record. Source: HHS OIG, Exclusions database help.
What a good screening record shows
If an auditor, payer or OIG asks, you want to show not just that you screened but how. A record that holds up answers six questions for every check:
- Who was checked: the full legal name and any other names searched.
- When: the date and time of the check.
- Against what: which list and which month’s version. Our tool prints the date of OIG’s file it used.
- What was found: no match, or the possible matches and how each was resolved.
- Who ran it: the staff member responsible.
- What happened next: for a confirmed match, the actions taken and when.
Keep these records with your compliance files, not loose in email. A simple folder per month with one PDF per check, or one combined report, is enough. If you outsource screening, ask for the same information in the vendor’s reports.
If you find a possible match
Most name matches are different people with the same name. Handle a possible match carefully and in this order:
- Don’t act on a name alone. Compare city, state, date of birth year and specialty from the match with your records.
- Verify on OIG’s site. Enter the person’s SSN or the business’s EIN in OIG’s online search to confirm or rule out the match.
- If confirmed, stop federally reimbursed work at once. Remove the person from any role tied to federal program payment and stop billing for their services.
- Work out what was paid. Identify claims tied to the person’s work since the exclusion date. Overpayments must be returned within 60 days of being identified.
- Take legal advice and consider self-disclosure. OIG’s Self-Disclosure Protocol is the route OIG points providers to for resolving liability.
- Document everything. Dates you checked, what you found, and what you did.
Reinstatement and waivers
An exclusion does not end on its own. When the period is over, the person must apply to OIG for reinstatement, and they remain on the LEIE until OIG approves it. Once reinstated, they are removed from the current list. That is why someone excluded years ago can still appear today.
Some entries also show a waiver, which allows a specific provider to keep serving patients in a particular state or program, usually where access to care would otherwise suffer. A waiver is narrow: it covers only what it names. Our check shows waiver details when OIG lists them.
Ten common mistakes
- Screening only clinicians. Billing and administrative staff count.
- Checking once at hire. People are excluded after they join you.
- Searching only by NPI. Most entries don’t have one.
- Ignoring former names. People can be listed under a maiden or previous name.
- Trusting a vendor without proof. OIG says liability stays with you.
- Firing on a name match. Confirm with the SSN first.
- Keeping no records. An undocumented check is hard to prove.
- Checking only the LEIE. SAM.gov and state Medicaid lists can differ.
- Assuming exclusions expire. Reinstatement requires an application.
- Waiting to repay. The 60-day clock starts when an overpayment is identified.
Pro tips
What isn’t settled
Questions
Is OIG exclusion screening required by law?
No statute or regulation requires a private practice to screen. But federal programs won’t pay for anything an excluded person furnishes, and you can be fined if you knew or should have known someone was excluded. OIG says monthly screening best minimizes that risk, so in practice it is expected.
How often should we check the OIG list?
Before hiring or contracting, and then monthly. OIG updates the list by the 10th of each month, and its advisory bulletin says monthly screening “best minimizes” overpayment and penalty risk.
Do front-desk and billing staff need to be checked?
Yes. OIG’s bulletin covers administrative and management work paid for directly or indirectly by federal programs, including billing, accounting, HR and leadership roles.
What is the fine for employing an excluded person?
The statute sets up to $20,000 per item or service, plus up to three times the amount claimed. After HHS’s inflation adjustment published in January 2026, the maximum is $25,595 per item or service. OIG can also exclude the employer.
Can we hire an excluded person at all?
Only in limited cases, for work that no federal health program pays for, directly or indirectly. OIG warns that this is narrow for any provider that bills federal programs.
Is a name match proof that someone is excluded?
No. Many people share names. Confirm a possible match with the person’s Social Security number (or a business’s EIN) on OIG’s own online search before taking action.
Do we need to check SAM.gov too?
Many payers and state Medicaid programs expect it. State Medicaid agencies themselves must check both the LEIE and SAM at least monthly, and many pass that expectation on to providers in their agreements.
Does an exclusion end automatically?
No. When the period ends, the person must apply to OIG for reinstatement and stays on the list until OIG approves it.
Can we rely on our staffing agency’s screening?
You may, but OIG recommends verifying it, for example by asking for screening records. Liability stays with you.
What should we do if a current employee turns out to be excluded?
Remove them from any federally reimbursed work at once, stop billing for their services, work out what was paid, take legal advice and consider OIG’s Self-Disclosure Protocol. Overpayments must be reported and returned within 60 days of being identified.
Sources
Each link opens the original in a new tab.
- HHS OIG, Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs (May 8, 2013) — what exclusion covers, who to screen, monthly screening recommendation, contractor screening, self-disclosure
- 42 U.S.C. § 1320a-7a (civil monetary penalties) — the civil monetary penalty for employing or contracting with an excluded person
- Federal Register, Annual Civil Monetary Penalties Inflation Adjustment (HHS, January 28, 2026) — the inflation-adjusted penalty amount in force in 2026
- HHS OIG, Background Information and Exclusion Authorities — exclusion authorities, mandatory and permissive exclusions and minimum periods
- HHS OIG, LEIE downloadable database — the monthly LEIE file our tool and charts are built from
- HHS OIG, Exclusions database help — monthly update timing and verifying a match with an SSN or EIN
- 42 CFR § 455.436, State Medicaid database checks (Cornell LII) — monthly LEIE and SAM checks by state Medicaid agencies
- 42 U.S.C. § 1320a-7k(d), reporting and returning overpayments (Cornell LII) — the 60-day rule for reporting and returning overpayments
- Faegre Drinker, HHS-OIG updates its Self-Disclosure Protocol (November 2021) — Self-Disclosure Protocol minimum settlement and multiplier
- SAM.gov, Entity information and exclusions search — the federal exclusions search
- CMS NPPES NPI Registry — NPI lookups
- OIG, Liberty County Hospital District No. 1 and PF Carthage SNF Ops agreed to pay $525,000 (August 2026) — settlement amount and date
- OIG, Advanced Health Care of Colorado Springs agreed to pay $500,000 (July 2026) — settlement amount and date
- OIG, Dialysis Care Center agreed to pay $254,000 (August 2026) — settlement amount and date
- OIG, Barnet Dulaney Perkins Eye Center agreed to pay $175,000 (May 2026) — settlement amount and date
- OIG, Cookeville Regional Medical Center agreed to pay $20,000 (June 2026) — settlement amount and date
This guide gives general information, not legal or compliance advice. Confirm any possible exclusion match on OIG’s website and take legal advice before acting on a confirmed match. Last checked October 21, 2026.