Most exclusion screening programs start with staff, because that is the list HR already has. The payment rule does not stop there. It is about who furnishes an item or service a federal health care program pays for, directly or indirectly — and a large share of that work is done by people and companies you contract with.
The rule reaches contractors
No federal health care program payment may be made for items or services furnished by a person on an exclusion list (42 C.F.R. § 1001.1901). The OIG's 2013 Special Advisory Bulletin is explicit that this does not depend on the relationship: whether the person is "an employee, subcontractor, employee of contractor, or volunteer," the provider "is subject to overpayment liability" for items or services a person on the list furnished that a federal health care program paid for.
Which contractors to screen
The bulletin tells providers to decide about contractors, subcontractors and the employees of contractors "using the same analysis that they would for their own employees." The question is whether the work ends up, directly or indirectly, in something a federal program pays for.
It names examples where the OIG recommends screening:
- nurses provided by staffing agencies
- physician groups that contract to provide coverage, such as emergency room coverage
- billing and coding contractors
The same reasoning reaches further for many organizations: locum and per-diem clinicians, therapy and home health subcontractors, medical suppliers and equipment vendors, management companies, and owners, officers and managing employees. Pharmacies, laboratories, imaging centers and equipment suppliers have one more group to think about: the bulletin notes that items or services ordered or prescribed by a physician on the list are not payable, so ordering and prescribing physicians belong in the check at the point of service.
Relying on the contractor's own screening
You do not always have to screen a contractor's people yourself. The bulletin says a provider "could choose to rely on screening conducted by the contractor" — a staffing agency, a physician group, a billing company — but recommends that the provider validate that the screening is happening, "by requesting and maintaining screening documentation from the contractor."
In practice that means a contract clause that requires the screening, plus the contractor's monthly evidence on file: who they checked, against which lists, on what date. If the evidence stops arriving, the reliance stops being documented.
What you need to screen a vendor or contractor
Collect identifiers when the relationship starts, because a name alone produces potential matches you cannot resolve:
- Individuals: full legal name, date of birth, NPI where they have one, and license numbers.
- Organizations: legal name and any names they do business under, EIN, and organizational NPI. The NPPES NPI registry confirms an NPI and the name it belongs to.
Then check them the same way you check staff: before the relationship starts and every month after, against the LEIE, SAM.gov — which matters more for vendors, because it carries government-wide procurement exclusions — and your state's Medicaid list, as set out in the state requirement guides. A name that matches an entry is a potential match — verification required, never a conclusion on its own; see what to do when you find a potential match.
Keeping it manageable
Vendor lists change more than staff lists do, and nobody owns them the way HR owns a roster. The programs that keep up treat the vendor list as one more monitored list: imported once, tagged as vendors and contractors, and re-screened monthly with the staff.
That is how Exclia works: import a CSV of staff, contractors and vendors, label each record, and every monthly run checks all of them against every list with a dated record. Monitoring for vendor compliance shows the setup. To see what the lists say about one vendor or person now, run a free check.
This page explains published guidance, with the sources linked below so you can read them yourself. It is not legal advice.