What is the NPDB?
I. What is the NPDB The National Practitioner Data Bank (NPDB) was created as part of the Health…
Category Exclusion Screening
Exclusion screening is the federal and state compliance obligation to verify that healthcare employees, vendors, and contractors are not barred from participating in Medicare, Medicaid, or other federally-funded programs. Every healthcare provider that bills a federal program is required to screen upon hire and monthly thereafter against the OIG LEIE, GSA/SAM, and all 44 state Medicaid exclusion lists. Failure to screen exposes providers to civil money penalties of up to $24,947 per violation, overpayment liability, and potential False Claims Act exposure. This section of the site is the definitive hub for exclusion screening compliance: the pillar guides, state-by-state requirements, enforcement trends, and the regulatory framework explained by the former federal prosecutors who built it.
Read MoreWhat is the NPDB?
What is the Length of A Mandatory Exclusion?
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) is responsible for overseeing the…
What is the Scope of a Mandatory Exclusion Brought Under Section 1128(a)(4) of the Social Security Act (Act)?
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) exercises both mandatory and permissive…
Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B) — The Collateral Consequences of a State Medicaid Enrollment Termination Action
Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B) (November 2020): Since 1976, the Department of Health and Human Services…
Which Federal & State Exclusion Lists Should Be Screened?
The complex web of regulation encompassing government health care dollars is a lot to take on. With 41…
A State Conviction for “Patient Neglect” Will Result in Mandatory Exclusion from Participation in Federal Health Benefit Programs
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) may be required by law…
I Have a Confirmed Exclusion What are my Options
After finding a confirmed exclusion among your employees, vendors, contractors, or volunteers there are several options you can…
Massachusetts Medicaid Exclusion Screening Requirements
Massachusetts Executive Office of Health and Human Services maintains the Massachusetts MassHealth Provider Suspension and Exclusion List —…