Healthcare exclusion screening checklist Source guidance reviewed: 2026-10-03 Use this worksheet for your current workforce, contractors, and vendors. Select sources and timing for your programs, states, roles, and contracts; completing it does not certify compliance. RUN RECORD Organization / team: ____________________ Run date / owner / backup / reviewer: ____________________ Compliance escalation owner / deadlines: ____________________ Roster version / number of people and entities: ____________________ Programs / states / contracts in scope: ____________________ PREPARE THE ROSTER [ ] Assign a screening owner and a reviewer for unresolved results. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening [ ] Reconcile the roster with current workforce and vendor records; record additions, departures, and the roster version. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening [ ] Include relevant contracted and support roles, based on whether their work is paid directly or indirectly by federal healthcare programs. Guidance: OIG guidance on screening scope and timing — https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/ [ ] Collect legal names, known former names or aliases, and available identifiers through approved internal channels. Guidance: OIG search and identity-verification instructions — https://oig.hhs.gov/exclusions/leie-quick-tips-instructions/ Notes / evidence location: ____________________ CHOOSE SOURCES AND TIMING [ ] Include the OIG LEIE for OIG exclusions. Identify any additional state Medicaid, payer, or contract sources that apply and record the authority for each. Guidance: OIG guidance on screening scope and timing — https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/ [ ] Record each source’s URL, data edition or update date, and the date searched. A failed or unavailable source is an incomplete check, not a clear result. Guidance: OIG guidance on screening scope and timing — https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/ [ ] Set the next run date and record its basis: organizational policy, agency guidance, or a specific state or contract requirement. Guidance: OIG guidance on screening scope and timing — https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/ Notes / evidence location: ____________________ SCREEN NEW HIRES AND VENDORS BEFORE ENGAGEMENT [ ] Screen prospective employees, contractors, and in-scope vendor personnel before employment or contracting; record the check date and onboarding decision. Guidance: OIG guidance on screening scope and timing — https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/ [ ] When relying on a staffing agency or vendor to screen, obtain and retain documentation showing who was checked, when, and against which sources; validate that the agreed screening occurred. Guidance: OIG guidance on screening scope and timing — https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/ [ ] Assign potential matches to a reviewer and escalate unresolved cases before approving affected work. Add engaged people and entities to the recurring roster. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening Notes / evidence location: ____________________ OWN AND MONITOR RECURRING SCREENING [ ] Name a run owner, backup, match reviewer, and compliance escalation owner; document responsibilities and follow-up deadlines. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening [ ] Schedule recurring checks using the documented timing basis. OIG recommends monthly LEIE checks; verify any state, payer, or contract duties separately. Guidance: OIG guidance on screening scope and timing — https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/ [ ] Reconcile screened counts with the roster and selected sources. Investigate missed runs, failed searches, and stale data; repeat affected checks and track open reviews. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening Notes / evidence location: ____________________ RUN AND DOCUMENT SEARCHES [ ] Search each selected source using its official instructions, including relevant name variations. Guidance: OIG search and identity-verification instructions — https://oig.hhs.gov/exclusions/leie-quick-tips-instructions/ [ ] Save the initial search results and any follow-up searches, including searches with no results. Guidance: OIG search and identity-verification instructions — https://oig.hhs.gov/exclusions/leie-quick-tips-instructions/ [ ] If using downloaded LEIE data, use a current full file or correctly apply both exclusion and reinstatement supplements; record which version was used. Guidance: OIG search and identity-verification instructions — https://oig.hhs.gov/exclusions/leie-quick-tips-instructions/ Notes / evidence location: ____________________ RESOLVE POSSIBLE MATCHES [ ] Treat a matching name as a possible match pending identity review; compare available identifying details. Guidance: OIG search and identity-verification instructions — https://oig.hhs.gov/exclusions/leie-quick-tips-instructions/ [ ] For a possible LEIE match, use OIG’s online SSN or EIN verification. If identity remains uncertain, contact OIG for assistance and keep the case unresolved. Guidance: OIG search and identity-verification instructions — https://oig.hhs.gov/exclusions/leie-quick-tips-instructions/ [ ] Record the reviewer, evidence, disposition, and review date. Escalate confirmed or unresolved cases to the designated compliance owner for decisions about affected work, payments, and reporting. Guidance: OIG exclusion and reinstatement FAQs — https://oig.hhs.gov/faqs/exclusions-faq/ [ ] Do not infer reinstatement from an elapsed exclusion period; verify current status with the issuing authority. Guidance: OIG exclusion and reinstatement FAQs — https://oig.hhs.gov/faqs/exclusions-faq/ Notes / evidence location: ____________________ CLOSE THE RUN AND RETAIN EVIDENCE [ ] List missing roster entries, unavailable sources, and open match reviews; assign an owner and follow-up date for every gap. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening [ ] Retain the roster version, source versions, search evidence, and review decisions under your organization’s retention and access policies. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening [ ] Record reviewer sign-off and the next screening date. A run with open gaps should remain marked incomplete. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening Notes / evidence location: ____________________ PREPARE AN AUDIT EVIDENCE PACKET [ ] Index the roster snapshot, source register, search results, match decisions, vendor evidence, and sign-off by run date in an approved evidence location. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening [ ] Walk through a sample record from roster to search to disposition so a reviewer can reconstruct the check, including any verification evidence. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening [ ] Include incomplete runs, outstanding cases, corrective actions, owners, and due dates. Confirm access controls and the applicable retention policy; do not treat a downloaded report as compliance certification. Guidance: Monthly screening workflow and evidence guidance — https://exclia.com/guides/monthly-exclusion-screening Notes / evidence location: ____________________ SOURCE LOG (repeat for each source) Source / official URL: ____________________ Why applicable / timing authority: ____________________ Data version / update date / searched at: ____________________ Result / evidence location / availability gaps: ____________________ MATCH REVIEW (repeat for each possible match) Internal subject reference / source record reference: ____________________ Verification method / evidence location: ____________________ Disposition: unresolved / different identity / confirmed match Reviewer / review date / escalation owner: ____________________ Follow-up action / due date: ____________________ Store sensitive identifiers only in approved systems; do not write SSNs or EINs here. RUN SIGN-OFF Status: incomplete / complete Open gaps / owners / due dates: ____________________ Reviewer / sign-off date: ____________________ Next run date / timing basis: ____________________ Retention policy / evidence location: ____________________ OFFICIAL SOURCES OIG: Effect of Exclusion — screening scope, frequency, and documentation https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/ OIG: LEIE Quick Tips & Instructions — searching and identity verification https://oig.hhs.gov/exclusions/leie-quick-tips-instructions/ OIG: Exclusions FAQs — possible matches and reinstatement https://oig.hhs.gov/faqs/exclusions-faq/ Resource: https://exclia.com/guides/exclusion-screening-checklist