"Exclusion screening" is one of those obligations that everyone agrees exists and few people can point to in a regulation. That is because it comes from three different places at once: a federal payment rule, federal guidance about how to stay clear of it, and state provider agreements that turn the guidance into a term of participation.
This page separates the three, so you can tell which part of your program is a rule and which part is a practice you have chosen.
The rule underneath everything
No federal health care program payment may be made for items or services furnished by a person on an exclusion list, or directed or prescribed by a listed physician (42 C.F.R. § 1001.1901). The OIG's 2013 Special Advisory Bulletin explains how wide that goes: it reaches administrative and management services with no patient contact, and it reaches salary and benefits paid from federal program funds.
The exposure attaches to the organization that submits the claim. Where an organization arranges or contracts with a person on the list to provide items or services reimbursable by a federal program, the OIG may seek civil monetary penalties of up to $10,000 for each item or service — a statutory figure, adjusted annually for inflation — plus an assessment of up to three times the amount claimed.
The standard is the phrase worth memorising: liability attaches when the organization knew or should have known that the person was on the list. "Should have known" is what converts a public list into an obligation to look at it. Nobody has to prove you knew; they have to show the information was there to be found.
What the OIG asks providers to do
Here is the part that is often reported as a rule and is not one. Federal law does not order a provider to search the LEIE on a schedule. The OIG's guidance recommends one, and states the reasoning plainly in the 2013 bulletin: it updates the LEIE monthly, so screening each month is what best limits potential overpayment and penalty exposure.
The distinction matters, and not only for accuracy. A recommendation you have adopted is a commitment your own compliance program is measured against. A monthly rhythm that quietly becomes a quarterly one is a gap you documented yourself.
What the states require
State Medicaid programs are where the obligation usually becomes binding rather than advisory.
State Medicaid agencies are themselves required to check federal databases no less frequently than monthly (42 C.F.R. § 455.436). Separately, many states pass the same expectation to providers through the provider agreement or through the participation regulation itself — and those states name their own list alongside the federal ones.
Because the requirement, the interval, and the penalties differ by state, we keep one page per state, each citing that state's own sources: see the state requirement guides.
Which lists count
Three, for most organizations.
The LEIE, published monthly by the OIG, which is the federal exclusion list and the one the guidance above is about.
SAM, the System for Award Management, which carries the government-wide record of parties barred from federal procurement and non-procurement programs. It is a wider net than health care, and it is a separate search.
Your state's Medicaid list, where your state keeps one. Roughly forty do, published under various names and refreshed on various schedules.
A check of the LEIE alone is not a check of all three, and a state auditor asking about your program will usually ask about theirs.
Who has to be checked
The payment rule is about who furnishes an item or service that a federal program pays for, directly or indirectly. In practice, that reaches further than most rosters do at first:
- staff, clinical and non-clinical alike
- contractors and locum staff
- vendors and suppliers whose goods or services are billed to a federal program, directly or indirectly
- owners, officers, and managing employees
- referring and ordering physicians, where your claims depend on them
If a person or organization's work ends up inside something you bill, they belong on the list of records you check.
What "documented" means
The obligation is to check. The thing that helps you afterwards is the record that you checked.
The OIG's own guidance asks providers to keep documentation of the search performed and of any further searches used to verify a potential name match. In an audit, three facts are what make a record worth having: who was checked, against which version of which list, and on what date. A screenshot from a search you ran eighteen months ago, with no list version on it, answers the first and none of the rest.
This is the reason Exclia records the immutable version identifier of every list a screening reads, and shows you the date that version was retrieved. Our coverage page publishes the same information for every source we screen, before you pay for anything.
What this page is not
It is an explanation of published requirements, with the sources linked below so you can read them yourself. It is not legal advice, and it does not tell you what to do about a specific person or a specific contract — that is a decision for your organization and its own counsel.
If you want to see what the federal lists currently say about one name, the free checker searches the LEIE and SAM and shows you the list version behind the answer. If you are looking at a potential match already, read what to do when you find a potential match.