Who Can Request An Exclusion Waiver?
Authorized Requester Only the administrator of a Federal or state health care program (e.g., Medicare or Medicaid director)…
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 MoreWho Can Request An Exclusion Waiver?
Exclusions can be Devastating for Small Practices
Exclusions from participation in federal and state healthcare programs represent a significant and often devastating threat to healthcare…
What Does It Mean To Be On An Exclusion List?
Being on an exclusion list means that an individual or entity has been barred from participating in a…
How Providers Can Check OIG Exclusions on Their Own
This guide helps ensure compliance by verifying that individuals and entities are not excluded from participation in federal healthcare programs (Medicare, Medicaid, etc.) using the OIG’s online lookup tool.
Top 5 Challenges in Exclusion Monitoring and How to Solve Them
Exclusion monitoring is a mandatory and complex compliance function critical to minimizing liability risks for healthcare providers. The…
What to Do If You Have a Confirmed Exclusion
Finding out that an employee, vendor, contractor, or volunteer has a confirmed exclusion is a serious compliance emergency.…
Why is it Necessary to Screen the NPPES Registry Database?
We are sometimes asked, “Why do you screen against the National Plan and Provider Enumeration System (NPPES).” That…
A Provider’s Guide to New York Medicaid Exclusion Screening
This article focuses on helping providers understand New York Medicaid exclusion screening law, and its exclusion screening requirements so that they can avoid the risks associated with employing or doing business with excluded parties.