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Exclusion Screening Shed Archaic. Embrace– CONVERSATIONAL COMPLIANCE ™ Contact Us > Book a Demo > width="560" height="560" style="display:block; width:560; height:auto;"> Verify Everything. Miss Nothing. One-stop portal to identify and resolve compliance screening issues – fast! STAY AHEAD WITH TRUE REAL-TIME EXCLUSION SCREENING Stay compliant with ease— our software scans for new exclusions hourly using the Primary Source, checking your entire roster and notifying you within minutes. Immediate Alerts Faster Risk Mitigation Automated Monitoring Customizable Frequency Learn more Recent OIG Penalties & Affirmative Exclusions Castle Biosciences Agreed to Pay $112,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded IndividualJanuary 9, 2026 – After it self-disclosed conduct to OIG, Castle Biosciences, Inc. (Castle), Friendswood, Texas, agreed to pay $112,917.55 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Castle employed an individual that it knew or should have known was excluded from participation in Federal health care programs. Read more Optima Medical Agreed to Pay $106,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded IndividualDecember 18, 2025 – After it self-disclosed conduct to OIG, Prescott Healthcare Solutions d/b/a Optima Medical (Optima Medical), Scottsdale, Arizona, agreed to pay $106,388.13 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Optima Medical employed an individual that it knew or should have known was excluded from participation in Federal health care programs. Read more Community Hospital San Bernadino Agreed to Pay $112,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded IndividualDecember 11, 2025 – After it self-disclosed conduct to OIG, Community Hospital San Bernadino (CHSB), San Bernadino, California, agreed to pay $112,390.20 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CHSB employed an individual that it knew or should have known was excluded from participation in Federal health care programs. Read more St. John's Regional Medical Center Agreed to Pay $357,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded IndividualDecember 11, 2025 – After it self-disclosed conduct to OIG, St. John’s Regional Medical Center (St. John), Oxnard, California, agreed to pay $357,943.89 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that St. John employed an individual that it knew or should have known was excluded from participation in Federal health care programs. Read more PreviousNext Trusted by over 10,000 establishments Learn why over 10,000 establishments have trusted us to streamline their workflow for more than a decade. Learn More Contact us  info@streamlineverify.com  855-VERIFY-8 (837-4398)  635 Duquesne BoulevardBrick Township, NJ 08723 First Name* Last Name* Email* Phone* Company Name* TopicTopicSalesTechnical SupportBillingOther Number of EmployeesNumber of employees1-5051-200201-500501-1,0001,001-5,0005,001-10,00010,001+ WebinarWould you like to schedule a webinar?YesNo Number of EmployeesNumber of employees1-5051-200201-500501-1,0001,001-5,0005,001-10,00010,001+ Webinar?Would you like to schedule a webinar?YesNo Message SEND MESSAGE Δ Service levels Verify Professional A one-stop portal that screens & auto-resolves potential matches on the spot. Verify Enterprise Harness the power of our resolution team of experts & guarantee exclusion compliance effortlessly. License Monitoring Harness the power of Streamline Verify to access the real-time status of all your providers. OIG Exclusion Screening State Medicaid Screening Sanction Monitoring Death Master File OFAC Board Actions CMS Preclusion API Integration EXPLORE THE FUTURE OF COMPLIANCE FAQS General Areas of healthcare Types of clients Databases New databases Downloads License monitoring Criminal background checks Security Client data Business continuity plan SSN's Certified secure Liability Performance Increased efficiency False positive Reporting Audits End of service Getting Started Pricing discounts Implementation Customer care Third party services × Federal Sanction Lists Federal Department of Commerce Department of State Department of Treasury State Medicaid Lists Exclusion Data Heatmap State Medicaid Lists International Lists Miscellaneous Sanction Lists Licensing Lists State Licensing Boards National All Databases API Integration There is a better way! Verify Everything.Miss Nothing. Learn More × Understanding OIG Exclusions OIG Exclusions Screening Process Exclusion FAQS Quick OIG Exclusion Basics Employing Excluded Individuals Consequences to Employing an Excluded Individual OIG Compliance Law Laws and Publications on OIG Compliance More Compliance Resources OIG Compliance List LEIE OIG Check Ask Me Anything × Blog Stay ahead of healthcare compliance - updates that matter. Ask Me Anything Clear answers. Cleaner compliance. Exclusion Compliance Understand exclusions. Reduce risk. Security First ✓ Cloud hosted ✓ Encrypted data ✓ Real-time backups Trusted for Accuracy ✓ Physical security ✓ Restricted access ✓ Single sign-on ✓ Password security ✓ Certified secure ✓ Cross checking HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY Learn More 5 60% Average workload reduction by implementing the Streamline Verify program 5 10K Establishments trust Streamline Verify nationwide 5 2011 Serving the healthcare industry’s unique compliance needs since 2011 5 24X Setting standards with hourly synchronization to primary source data × Our Culture We build the best, so you can perform at your best. About Us The Team Trusted for Good Reason ✓ Guaranteed accurate ✓ Certified Secure ✓ Audit Proof ✓ Feature-rich reporting ✓ Round the clock real-time-data ✓ Processing fully automated Security First ✓ Cloud hosted ✓ Encrypted data ✓ Real-time backups Trusted for Accuracy ✓ Physical security ✓ Restricted access ✓ Single sign-on ✓ Password security ✓ Certified secure ✓ Cross checking HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY Learn More 5 60% Average workload reduction by implementing the Streamline Verify program 5 10K Establishments trust Streamline Verify nationwide 5 2011 Serving the healthcare industry’s unique compliance needs since 2011 5 24X Setting standards with hourly synchronization to primary source data × --- Service levels Verify Professional A one-stop portal that screens & auto-resolves potential matches on the spot. Verify Enterprise Harness the power of our resolution team of experts & guarantee exclusion compliance effortlessly. License Monitoring Harness the power of Streamline Verify to access the real-time status of all your providers. OIG Exclusion Screening State Medicaid Screening Sanction Monitoring Death Master File OFAC Board Actions CMS Preclusion API Integration EXPLORE THE FUTURE OF COMPLIANCE FAQS General Areas of healthcare Types of clients Databases New databases Downloads License monitoring Criminal background checks Security Client data Business continuity plan SSN's Certified secure Liability Performance Increased efficiency False positive Reporting Audits End of service Getting Started Pricing discounts Implementation Customer care Third party services × Federal Sanction Lists Federal Department of Commerce Department of State Department of Treasury State Medicaid Lists Exclusion Data Heatmap State Medicaid Lists International Lists Miscellaneous Sanction Lists Licensing Lists State Licensing Boards National All Databases API Integration There is a better way! Verify Everything.Miss Nothing. Learn More × Understanding OIG Exclusions OIG Exclusions Screening Process Exclusion FAQS Quick OIG Exclusion Basics Employing Excluded Individuals Consequences to Employing an Excluded Individual OIG Compliance Law Laws and Publications on OIG Compliance More Compliance Resources OIG Compliance List LEIE OIG Check Ask Me Anything × Blog Stay ahead of healthcare compliance - updates that matter. Ask Me Anything Clear answers. Cleaner compliance. Exclusion Compliance Understand exclusions. Reduce risk. Security First ✓ Cloud hosted ✓ Encrypted data ✓ Real-time backups Trusted for Accuracy ✓ Physical security ✓ Restricted access ✓ Single sign-on ✓ Password security ✓ Certified secure ✓ Cross checking HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY Learn More 5 60% Average workload reduction by implementing the Streamline Verify program 5 10K Establishments trust Streamline Verify nationwide 5 2011 Serving the healthcare industry’s unique compliance needs since 2011 5 24X Setting standards with hourly synchronization to primary source data × Our Culture We build the best, so you can perform at your best. About Us The Team Trusted for Good Reason ✓ Guaranteed accurate ✓ Certified Secure ✓ Audit Proof ✓ Feature-rich reporting ✓ Round the clock real-time-data ✓ Processing fully automated Security First ✓ Cloud hosted ✓ Encrypted data ✓ Real-time backups Trusted for Accuracy ✓ Physical security ✓ Restricted access ✓ Single sign-on ✓ Password security ✓ Certified secure ✓ Cross checking HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY Learn More 5 60% Average workload reduction by implementing the Streamline Verify program 5 10K Establishments trust Streamline Verify nationwide 5 2011 Serving the healthcare industry’s unique compliance needs since 2011 5 24X Setting standards with hourly synchronization to primary source data × Words we live by: Access the latest technology. Optimize your talent. Create extraordinary  results. Contact Us Tell me more Tell me more We’re industry leaders in exclusion screening software solutions. Streamline Verify has revolutionized exclusion screening. Simple to use, state-of-the-art, efficient, automated software designed to meet all your compliance screening needs. With our data science technology fully automate your exclusion screening, scan OIG exclusion lists with ease and automatically resolve potential issues as they arise. Remove frustration and save time and money, with our customized exclusion screening software options, designed to maximize your performance. Vision leads the way. Founded in 2011, by CEO Joe Stefansky, Streamline Verify was formed to create impactful change and efficient solutions that would transform the healthcare compliance industry. Our CEO is focused on constantly developing user-friendly software, that offers greater capabilities and streamlined processes. His passion for harnessing the power of technology to ensure both employees and clients perform to their max is what drives us forward. Health Compliance Fun We automate compliance. What began solely as a way to scan exclusion screening databases, has since evolved to meet the growing needs of compliance officers. As a business, we pride ourselves on: Continually adapting & improving Robust automation & capabilities Industry specific screening OUR MISSION To design exclusion screening software that enables you to maximize your potential, amplify your skills & streamline your processes. We build the best, so you can perform at your best. As a business, we understand the importance of your talent, skills and role as a healthcare compliance officer. Designed to make your job easier and supercharge your skillset, our software ensures you are at the top of your game. As a company, we endeavour to create a supportive environment that encourages personal growth and meets the needs of both employees and clients. We aim to understand, adapt and respond to the ever-changing requirements and regulations of the healthcare compliance industry. We build solutions for problems before they arise. Our technology is based upon an appreciation for automation and efficiencies, to provide healthcare compliance officers with software that is at the forefront of exclusion screening. Our cutting-edge technology and solutions optimize performance and maximise output. A company you can trust. We understand that your job is to protect healthcare organizations, and we believe it is our job to support and protect you.  Intuitive innovative technology We have designed products to meet your compliance needs, and the constantly evolving requirements of the healthcare system – saving you time and money. ~ Security & peace of mind Healthcare data is sensitive, and security comes first with our systems and procedures ensuring safeguarding of all data transmission and storage.  24/7 customer care & support We review feedback and conduct regular reviews, to improve our application and deliver software & solutions that exceed expectations – an intuitive, adaptive and responsive user interface and experience, that works for you. The future is here. We understand that no two clients are the same – our technology meets the various requirements, size, scope and scalability of each individual, and organization. When you partner with us, you partner with a business that cares and prides itself on enhancing the performance of its clients. We are constantly pushing the boundaries to deliver technology that transforms the exclusion screening process and optimizes your skillset and role as a dedicated healthcare compliance officer. Get in touch First Name* Last Name* Email* Phone* Company Name* TopicTopicSalesTechnical SupportBillingOther Number of EmployeesNumber of employees1-5051-200201-500501-1,0001,001-5,0005,001-10,00010,001+ WebinarWould you like to schedule a webinar?YesNo Number of EmployeesNumber of employees1-5051-200201-500501-10001001-50005001-10,00010,001+ Webinar?Would you like to schedule a webinar?YesNo Message SEND MESSAGE Δ Alternative:WPA --- Exclusion Compliance Like you, we put compliance first More Compliance Resources OIG Exclusion List OIG Check LEIE More to Come More Compliance Resources OIG Exclusion List OIG Check Lorem Ipsum Dolor Adipiscing Elit OIG Exclusion List Employing Excluded Individuals Exclusion FAQS OIG Compliance Law Understanding the OIG Exclusion List OIG Exclusions Screening Process What is OIG Exclusion Screening? Exclusion screening is the process of verifying that an employee or potential is not classified as an excluded individual who is prohibited from participation in any Federal health care program. What is the significance and process behind an OIG background check? An OIG background check is a vital part of healthcare background checks. Conducted by the U.S. Department of Health and Human Services (DHHS) Office of the Inspector General (OIG), it involves searching the List of Excluded Individuals and Entities (LEIE). This is a database that contains those who have been excluded from state and federal healthcare programs. If an applicant or employee is found on this list, the hiring organization risks losing the ability to contract with Medicare and Medicaid, as well as exposing itself to substantial financial penalties. Therefore, it’s critical for healthcare employers to not hire any employees, contractors, or volunteers who have been excluded during their period of exclusion. How does an employer find out if an individual or entity is excluded? The OIG does not issue individual warnings or notifications regarding excluded individuals. Employers are required to search the Federal Office of the Inspector General OIG Exclusion List database and SAM.gov , as well as each individual state’s Medicaid Exclusion Database, to verify each one of their employees. Various states require additional searches as well. How is an exclusion screening search performed? In healthcare exclusion screening searches are done as follows: The employer inputs the employee’s (or potential hire’s) name, date of birth into the database. The database returns a list of potential matches, including individuals with similar names. The employer must then independently verify whether or not the employee in question is, indeed, the same person as the excluded individual. Employers are also required to check all versions of each employee’s name, including maiden names, combined names (ie. Smith-Jones; Smith; and Jones), and name diminutives (i.e. Robert/Bob). Is the OIG Exclusions list the only database that must be searched? No, there are also other federal exclusions lists and state level databases that must be accessed for an exclusions search. Examples are: ● The General Services Administration (GSA) Systems for Awards Management (SAM) ● Office of Foreign Assets and Control (OFAC) ● Drug Enforcement Agency (DEA) Excluded Parties List ● State Medicaid Exclusion Lists Are employers really required to search each and every state’s data files? Yes. Although the OIG does maintain its own database of excluded individuals, individual states may exclude individuals for reasons other than the ones cited by Federal law, without immediately reporting to the OIG or to other states. The only way for employers to ensure compliance with the mandated requirement is to conduct a nationwide search each and every month. How often should employers and healthcare providers perform exclusion screening? All employees must be verified against all exclusion databases, each and every month. Is there any easier way to perform exclusion screening? Exclusion screening software, designed specifically for this purpose, can lighten the load of exclusion screening considerably.  The best software packages make exclusion screening virtually effortless. What is the difference between Sanctions and Exclusions? A healthcare sanction is the result of a disciplinary action taken by a state administrative body after it has determined that an individual or entity has violated an administrative rule, civil law or has committed a criminal offense. They can be found on the Office of Inspector General Sanctions list. The consequences for sanctions vary depending on the severity of the incident. Sanctions against health care staff are imposed for many reasons, including: Patient abuse/neglect Criminal conviction related to diversion of controlled substances Fraudulent billing for services and other forms of health care fraud Exclusion from participation in federal or state healthcare programs is a severe form of sanction. Exclusion prohibits a sanctioned provider from participating in federal healthcare programs or receiving federally funded reimbursement. Learn more about Sanction Screening > Employing an Excluded Individual Consequences to Employing an Excluded Individual What are the ramifications of keeping an excluded individual on staff? By law, companies or facilities that participate in government health care programs may not employ an excluded individual. Fines for violation typically range between $30,000 and $300,000. Can an OIG fine be reversed if the employer was unaware of the excluded status of an excluded employee? No. Ignorance of the employee’s status is not an acceptable excuse. Employers are required to screen every employee, across every Federal and State database, every month, including all variations of the employee’s name, such as maiden names and name diminutives. Can an employer bill for services performed by the excluded individual? Employers will not receive reimbursement from Federal health care programs (including Medicare, Medicaid, TRICARE, and the Veterans Health Administration) for any treatment or service performed by the excluded individual, nor for any treatment or medication prescribed by the excluded individual. Can an employer be sued for mistakenly firing an employee thought to be an excluded individual? Yes, an employer may be sued. Identical names commonly appear during the exclusions search screening process. It is the responsibility of an employer however to further verify that an employee or potential hire is in fact, excluded. What are some of the ways to further verify if an individual is the same person appearing on the OIG Exclusions list? The OIG Online Searchable Database will ask for the first and last name of the individual. Searchers can further establish the individual’s identity by matching the individual’s: ● Date of birth ● Address ● Social Security Number Exclusions FAQS Quick OIG Exclusion Basics Which government agency handles OIG Exclusions? The Office of Inspector General (OIG) handles OIG Exclusions. It is a part of the U.S. Department of Health and Human Services (HHS). The HHS-OIG is responsible for combating federal healthcare fraud, waste and abuse through OIG Exclusions. You can visit their website here https://exclusions.oig.hhs.gov . What is an OIG Exclusion? Exclusion in this context refers to a penalty issued by Medicaid and the Office of Inspector General (OIG) to individuals involved in the health care industry who have been convicted of specified crimes. If an individual is excluded, he or she may not participate as a provider in any Federal health care program. In addition, excluded individuals may not be employed by any Federal health care program participant. Who can be excluded? Any individual or entity convicted of the specified crimes or misdemeanors. Excluded individuals may include MDs, PAs, RNs, LPNs, CNAs, and therapists, amongst a host of others. How many types of exclusions are there? There are two types of exclusions: Mandatory Exclusions and Permissive Exclusions. Mandatory Exclusions are meted out as penalties for health care fraud/crimes; patient abuse; or unlawful distribution of controlled substances. The Office of Inspector General (OIG) is legally required to exclude individuals or entities convicted of such crimes for a minimum of five years. [42 U.S.C. § 1320a-7(a)]Permissive Exclusions are mandated as penalties under 16 different authorities, and may be issued due to loss of state license to practice; failure to repay student loans; conviction of certain misdemeanors; failure to provide quality care; or one of several other misdemeanors. [42 U.S .C. § 1320a-7(b)] Permissive exclusions are at the sole discretion of the OIG whether to place those guilty of misdemeanors related to federal or state healthcare programs under the LEIE. This includes reasons connected to professional competence, default in education loan obligations and financial integrity issues, among others. How long do OIG exclusions last? Mandatory exclusions can last depending on the number of offenses:[2]● Five years (1st offense) ● Ten years (2nd offense) ● Permanent exclusion (3rd offense) Permissive exclusions, on the other hand, can last at the discretion of the OIG. Placement on the OIG Exclusion database could be anywhere between one to three years.[3] Can those on the OIG Exclusion list (LEIE) charge federal healthcare programs for their goods or services? No.  By law, Federal health care programs may not pay for any item or service furnished, ordered, or prescribed by an excluded individual or entity.  This prohibition includes prescriptions for medications, as well as administrative or management services provided by the excluded individual. What is LEIE? The LEIE stands for the List of Excluded Individuals/Entities. Those found on this OIG sanctions list may not perform services or provide goods related to Medicare, Medicaid or other healthcare programs. How do you get out of the LEIE? The only way is through a reinstatement procedure which is not automatic. Your period of exclusion may have already ended however you must still apply for reinstatement. How frequently should employers check the OIG’s List of Excluded Individuals and Entities (LEIE)? The LEIE should be checked prior to extending an offer to any potential hire. Following hire, employers and contracting entities should check the LEIE for all current employees, contractors, vendors, interns and volunteers each month to prevent the continued employment of excluded individuals or entities. The OIG updates the LEIE each month. Failure to check monthly exposes an organization to potential breach of contract claims, civil monetary penalties and other administrative actions by state or federal authorities. Exclusion applies to more than direct care providers. Therefore, the monthly check of employees, contractors, and vendors against the current LEIE must not be limited to healthcare professionals primarily concerned with patient care. This review process should also include employees providing support services as well as administrative staff and managers. It does not matter if they do not have any interaction with patients. If such excluded individuals are connected to a business which is participating in federal or state healthcare programs, there is a potential violation of the law every time they carry out their functions in relation to that business. Many state Medicaid contracts expressly require that the LEIE be checked monthly to assure that no excluded individuals or entities serve or receive reimbursement for services provided to Medicaid enrollees. Medicaid contractors may be deemed to have knowledge of exclusion whether or not they check monthly. It should be noted that the ACA extended the reach of Medicaid exclusions through Section 6501 which prohibits any state from allowing an excluded Medicaid provider in one state from participation in Medicaid in any other state. To assure that your organization has not been added to a federal or state list in error, it is prudent to screen your own organization, its business names and its subsidiaries to avoid unwelcome surprises. Does the OIG List include any history of prior exclusions? No. The OIG list is intended to reflect only individuals and entities that are currently excluded from participation in government healthcare contracts. The LEIE also does not reflect reinstatement dates for those individuals and entities who apply for and are granted reinstatement. However, reinstatement is not automatic and is not guaranteed. Exclusion information is available to LEIE users in several forms. The full LEIE Database updated monthly is a complete inventory of all individuals or entities currently under exclusion and can include information that stretches over many years. The Monthly Supplement files contain only the reinstatements for one month or the exclusions for one month. The Reinstatement Supplement contains information not captured in either the full LEIE database or the monthly exclusion supplement. These monthly reinstatement files contain valuable information for potential employers to identify previously excluded parties when making hiring decisions. While employers can hire individuals or entities previously excluded, they may wish to better understand the prior actions of a potential hire that resulted in exclusion. The OIG Exclusion List and the CMS Preclusion List - are they related? Yes, they are, but they are not entirely consistent. The Preclusion List, updated monthly, provides the name of providers and prescribers who are precluded from receiving payment for Medicare Advantage (MA) plan items or services, or Medicare Part D drugs furnished or prescribed to Medicare beneficiaries. This payment limitation applies to MA plans, Medicare Cost plans and Programs of All-Inclusive Care for the Elderly (PACE) plans and Medicare Part D plans. Effective April 1, 2019, MA plans were required to deny payment for a health care item or service furnished by an individual or entity on the CMS Preclusion List and Part D plans were required to reject a pharmacy claim (or deny a beneficiary request for reimbursement) for a Part D drug prescribed by an individual on the Preclusion List. The CMS Preclusion List is comprised of any individual or entity that meets the following criteria: > Is currently revoked from the Medicare program and is under an active reenrollment bar, and CMS has determined that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program; > Has engaged in behavior for which CMS could have revoked the individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare Program, or > Have been convicted of a felony under federal or state law within the previous 10 years that CMS deems detrimental to the best interests of the Medicare program. The Preclusion List can include not only individual medical practitioners and providers, but also dentists, pharmacists, pharmacies, medical practices and medical suppliers. In addition, providers who voluntarily opt out of Medicare will appear on the Preclusion List. How These Lists are Related Use of the CMS Medicare Preclusion List does not eliminate the requirement that Medicare Advantage and Part D plans validate their providers monthly against the OIG’s LEIE. This list is updated monthly by the OIG to reflect exclusions from participation and payment under Medicare or Medicaid contracts due to criminal behavior. There is indeed substantial overlap between the lists but they are not entirely consistent: Providers excluded by the OIG’s LEIE will be on the CMS Preclusion List. OIG exclusions are imposed due to criminal behavior and as such are part of the CMS Preclusion List criteria. Therefore, if a plan finds a provider in the OIG LEIE, the plan is not required to check the CMS Preclusion List. However, there are other providers who are precluded by CMS from participation in a Medicare plan and yet will not appear on the OIG Exclusion List because the preclusion is based on other criteria. In that case, a MA or Part D plan should check the CMS Preclusion List as well. An additional factor to consider is why a provider was excluded or precluded. Once a provider is removed from the OIG’s LEIE and is no longer excluded due to a reinstatement by the OIG, a MA and Part D plan must then turn to the CMS Preclusion List because there are instances in which a provider remains precluded by CMS from plan participation even though they are no longer excluded by the OIG. For example, CMS may bar reinstatement from Medicare plan participation or perhaps the provider was precluded for behavior which CMS deems sufficiently problematic to warrant being removed from participation in a Medicare plan even though it did not result in a criminal conviction. Another difference between the two lists is data capture. Unlike the OIG’s LEIE list which deletes the names of providers who are reinstated or have completed their period of exclusion, impacted providers will not drop off the CMS Preclusion List. Instead, the updated CMS List will indicate a reinstatement date that an impacted provider is no longer precluded. The OIG issued a notice in 2022 that it considered whether to discontinue its publication of monthly supplements to the LEIE but as of December 2022, these are still available. How do individuals or companies end up on the OIG exclusion list? There are many reasons that an individual or organization can be excluded, as explained in some detail on the HHS OIG website as well as industry issuances. Most exclusions by the OIG start with a state’s report of a felony or misdemeanor criminal conviction or due to professional misconduct that resulted in sanction of a provider/entity by a state licensing board. For example, a nurse whose professional license is revoked (or voluntarily surrendered) due to a quality of care issue or drug abuse charge will be subject to exclusion at the federal level. States are required to notify the OIG of such actions taken. There are two types of exclusions that the OIG can impose. The misconduct or criminal action dictates which type of exclusion applies: Mandatory Exclusion. If an individual/entity is convicted of the following criminal offenses, the OIG is required by law to impose a minimum 5-year term of exclusion. The OIG has no discretion on decisions to exclude in cases that meet the statutory exclusion standards that include Health care fraud related to Medicare, Medicaid, SCHIP, or any state’s healthcare program; Patient abuse or neglect; and Felony conviction under Federal or State law relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct in connection with the delivery of a health care item or service. Permissive Exclusion. Unlike mandatory exclusions, the OIG has some discretion when imposing permissive exclusions and the term of exclusion. Permissive exclusion generally involves misdemeanor criminal convictions, as well as other lesser offenses, including default on student loans. If an OIG check results in a match, what should we do? For smaller organizations who have a limited number or employees, providers and contractors, checking the OIG Exclusion List may seem a quick monthly exercise. Simple exclusion screening searches are done as follows: The employer inputs the employee’s (or potential hire’s) name, date of birth into the database. The database returns a list of potential matches, including individuals with similar names. The employer must then independently verify whether or not the employee in question is, indeed, the same person as the excluded individual. Employers are also required to check all versions of each employee’s name, including maiden names, combined names (i.e., Smith-Jones; Smith; and Jones), and name diminutives (i.e., Robert/Bob). If you have all of the identifiers needed to definitively rule out any false positive or false negative potential matches, and have a very stable employee and contractor base, then how could there be a change in status from one month to another? In short, changes can be noted from month to month due to a number of factors, including delays by the OIG to upload information from the state Medicaid programs (which routinely submit updated exclusion information months late), delays by states to update their Medicaid exclusion lists, provider name changes or clarifications, and reinstatements into the Medicare program going into effect. If an organization chooses to pursue in-house exclusion checking, it needs to establish a dedicated resource who will not only check the LEIE and the GSA’s SAM List as required by contract, but also be prepared to research other databases such as state Medicaid exclusion lists (Medicaid providers), the CMS Preclusion List (for Medicare providers), state licensing board actions, as well as cross-checking provider identifiers such as their EIN or other national databases when names or information noted in the LEIE do not appear to clearly eliminate a potential match. Checking state exclusion databases is necessary because individual states may exclude individuals for reasons other than the ones cited by federal law, without immediately reporting to the OIG or to other states. The only way for employers to ensure compliance with the mandated requirement is to conduct a nationwide search each and every month. The complexity of the monthly OIG checking process for all organizations is daunting and very time intensive. To avoid failing to identify an excluded individual or entities, healthcare contractors often leverage the expertise of organizations such as Streamline Verify which have created proprietary software to compare information across all relevant databases and exclusion lists. By engaging a contractor to perform the required checks on a monthly basis, healthcare organizations can use their internal resources to address any potential matches that Streamline Verify has extensively vetted across multiple lists. This is a much more cost-effective approach that also guarantees a consistent monthly check to assure that an organization is not risking potential exposure to fines, penalties and findings OIG Compliance Law Laws and Publications on OIG Compliance Section 1128 of the Social Security Act: Exclusion of Certain Individuals and Entities Section 1128A of the Social Security Act: Civil Monetary Penalties Section 1128 of the Social Security Act: Exclusion of Certain Individuals and Entities Section 1128B of the Social Security Act: Criminal penalties for acts involving federal healthcare programs Section 1156 of the Social Security Act: Obligations of healthcare practitioners and providers Center for Medicaid and State Operations States must require providers to screen all employees and contractors monthly General Publishing Office: Effect of exclusion from participation in federal healthcare programs General Publishing Office: Denial of reinstatement if there is a violation of exclusion Section 1862 of the Social Security Act: Exclusions from Coverage and Medicare as secondary payer Databases Federal Sanction List State Medicaid List Misc Sanction List Licensing List Databases Federal Sanction List State Medicaid List Misc Sanction List Licensing List Contact us  info@streamlineverify.com  855-VERIFY-8 (837-4398)  100 Boulevard of the Americas, Lakewood NJ 08701 First Name* Last Name* Email* Phone* Company Name* Number of EmployeesNumber of employees1-5051-200201-500501-1,0001,001-5,0005,001-10,00010,001+ Message SEND MESSAGE Δ Service levels Verify Professional A one-stop portal that screens & auto-resolves potential matches on the spot. Verify Enterprise Harness the power of our resolution team of experts & guarantee exclusion compliance effortlessly. License Monitoring Harness the power of Streamline Verify to access the real-time status of all your providers. OIG Exclusion Screening State Medicaid Screening Sanction Monitoring Death Master File OFAC Board Actions CMS Preclusion API Integration EXPLORE THE FUTURE OF COMPLIANCE FAQS General Areas of healthcare Types of clients Databases New databases Downloads License monitoring Criminal background checks Security Client data Business continuity plan SSN's Certified secure Liability Performance Increased efficiency False positive Reporting Audits End of service Getting Started Pricing discounts Implementation Customer care Third party services × Federal Sanction Lists Federal Department of Commerce Department of State Department of Treasury State Medicaid Lists Exclusion Data Heatmap State Medicaid Lists International Lists Miscellaneous Sanction Lists Licensing Lists State Licensing Boards National All Databases API Integration There is a better way! Verify Everything.Miss Nothing. Learn More × Understanding OIG Exclusions OIG Exclusions Screening Process Exclusion FAQS Quick OIG Exclusion Basics Employing Excluded Individuals Consequences to Employing an Excluded Individual OIG Compliance Law Laws and Publications on OIG Compliance More Compliance Resources OIG Compliance List LEIE OIG Check Ask Me Anything × Blog Stay ahead of healthcare compliance - updates that matter. Ask Me Anything Clear answers. Cleaner compliance. Exclusion Compliance Understand exclusions. Reduce risk. Security First ✓ Cloud hosted ✓ Encrypted data ✓ Real-time backups Trusted for Accuracy ✓ Physical security ✓ Restricted access ✓ Single sign-on ✓ Password security ✓ Certified secure ✓ Cross checking HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY Learn More 5 60% Average workload reduction by implementing the Streamline Verify program 5 10K Establishments trust Streamline Verify nationwide 5 2011 Serving the healthcare industry’s unique compliance needs since 2011 5 24X Setting standards with hourly synchronization to primary source data × Our Culture We build the best, so you can perform at your best. About Us The Team Trusted for Good Reason ✓ Guaranteed accurate ✓ Certified Secure ✓ Audit Proof ✓ Feature-rich reporting ✓ Round the clock real-time-data ✓ Processing fully automated Security First ✓ Cloud hosted ✓ Encrypted data ✓ Real-time backups Trusted for Accuracy ✓ Physical security ✓ Restricted access ✓ Single sign-on ✓ Password security ✓ Certified secure ✓ Cross checking HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY Learn More 5 60% Average workload reduction by implementing the Streamline Verify program 5 10K Establishments trust Streamline Verify nationwide 5 2011 Serving the healthcare industry’s unique compliance needs since 2011 5 24X Setting standards with hourly synchronization to primary source data × --- Contact us Request a Webinar  info@streamlineverify.com  855-VERIFY-8 (837-4398)  635 Duquesne BoulevardBrick Township, NJ 08723 First Name* Last Name* Email* Phone* Company Name* TopicTopicSalesTechnical SupportBillingOther Number of EmployeesNumber of employees1-5051-200201-500501-1,0001,001-5,0005,001-10,00010,001+ WebinarWould you like to schedule a webinar?YesNo Number of EmployeesNumber of employees1-5051-200201-500501-1,0001,001-5,0005,001-10,00010,001+ Webinar?Would you like to schedule a webinar?YesNo Message SEND MESSAGE Δ Service levels Verify Professional A one-stop portal that screens & auto-resolves potential matches on the spot. Verify Enterprise Harness the power of our resolution team of experts & guarantee exclusion compliance effortlessly. License Monitoring Harness the power of Streamline Verify to access the real-time status of all your providers. OIG Exclusion Screening State Medicaid Screening Sanction Monitoring Death Master File OFAC Board Actions CMS Preclusion API Integration EXPLORE THE FUTURE OF COMPLIANCE FAQS General Areas of healthcare Types of clients Databases New databases Downloads License monitoring Criminal background checks Security Client data Business continuity plan SSN's Certified secure Liability Performance Increased efficiency False positive Reporting Audits End of service Getting Started Pricing discounts Implementation Customer care Third party services × Federal Sanction Lists Federal Department of Commerce Department of State Department of Treasury State Medicaid Lists Exclusion Data Heatmap State Medicaid Lists International Lists Miscellaneous Sanction Lists Licensing Lists State Licensing Boards National All Databases API Integration There is a better way! Verify Everything.Miss Nothing. Learn More × Understanding OIG Exclusions OIG Exclusions Screening Process Exclusion FAQS Quick OIG Exclusion Basics Employing Excluded Individuals Consequences to Employing an Excluded Individual OIG Compliance Law Laws and Publications on OIG Compliance More Compliance Resources OIG Compliance List LEIE OIG Check Ask Me Anything × Blog Stay ahead of healthcare compliance - updates that matter. Ask Me Anything Clear answers. Cleaner compliance. Exclusion Compliance Understand exclusions. Reduce risk. Security First ✓ Cloud hosted ✓ Encrypted data ✓ Real-time backups Trusted for Accuracy ✓ Physical security ✓ Restricted access ✓ Single sign-on ✓ Password security ✓ Certified secure ✓ Cross checking HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY Learn More 5 60% Average workload reduction by implementing the Streamline Verify program 5 10K Establishments trust Streamline Verify nationwide 5 2011 Serving the healthcare industry’s unique compliance needs since 2011 5 24X Setting standards with hourly synchronization to primary source data × Our Culture We build the best, so you can perform at your best. About Us The Team Trusted for Good Reason ✓ Guaranteed accurate ✓ Certified Secure ✓ Audit Proof ✓ Feature-rich reporting ✓ Round the clock real-time-data ✓ Processing fully automated Security First ✓ Cloud hosted ✓ Encrypted data ✓ Real-time backups Trusted for Accuracy ✓ Physical security ✓ Restricted access ✓ Single sign-on ✓ Password security ✓ Certified secure ✓ Cross checking HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY Learn More 5 60% Average workload reduction by implementing the Streamline Verify program 5 10K Establishments trust Streamline Verify nationwide 5 2011 Serving the healthcare industry’s unique compliance needs since 2011 5 24X Setting standards with hourly synchronization to primary source data ×