Healthcare Compliance Glossary
Key terms and definitions for exclusion screening and healthcare compliance.
C
CMP (Civil Money Penalty)
Financial penalties imposed by the OIG for violations of exclusion regulations. Penalties can reach up to $100,000 per item or service provided by an excluded individual, plus treble damages (three times the amount claimed). While CMPs are commonly associated with the OIG for exclusion violations, they can also be imposed by CMS in relation to other compliance violations, including those involving compliance hotlines. Organizations should establish a compliance hotline to help identify potential violations early.
E
Exclusion
A final administrative sanction imposed by the OIG that bars an individual or entity from participating in Federal and State healthcare programs including Medicare, Medicaid, and CHIP. See our FAQ for common questions about exclusions and reinstatement.
F
False Claims Act (FCA)
Federal law that imposes liability on persons and companies who defraud governmental programs. Knowingly employing an excluded individual can trigger FCA violations.
G
GSA SAM (System for Award Management)
The federal government’s primary database for entities that are debarred, suspended, or otherwise excluded from receiving federal contracts or assistance. SAM screening is a key component of vendor screening programs.
L
LEIE (List of Excluded Individuals and Entities)
The OIG’s database of individuals and entities excluded from participation in Medicare, Medicaid, and other federal healthcare programs. Updated monthly. Learn about how we screen the LEIE and other databases on your behalf.
M
Mandatory Exclusion
Exclusions that the OIG is required by law to impose, typically for convictions related to Medicare/Medicaid fraud, patient abuse, or felony controlled substance convictions. Minimum 5-year exclusion period.
Medicaid Exclusion List
State-level exclusion databases maintained by individual state Medicaid agencies. Currently 42+ states maintain separate exclusion lists that must be checked in addition to federal databases. View our full list of state exclusion databases.
N
NPI (National Provider Identifier)
A unique 10-digit identification number issued to healthcare providers. Used as one of multiple data points in identity verification during exclusion screening.
O
OIG (Office of Inspector General)
The division of the U.S. Department of Health and Human Services responsible for fighting fraud, waste, and abuse in Medicare, Medicaid, and other HHS programs. The OIG maintains the LEIE and has authority to impose exclusions and civil money penalties. Regular exclusion screening helps organizations stay compliant with OIG requirements.
P
Permissive Exclusion
Exclusions that the OIG may impose at its discretion for various offenses including fraud, obstruction of investigations, license revocation, or default on student loans. Exclusion period is typically 3 years minimum.
S
SAFER™
Exclusion Screening’s proprietary screening platform that screens against OIG LEIE, GSA SAM, all 46 state Medicaid exclusion databases, and the Social Security Death Master File with automated updates. See how it works.
Self-Disclosure
The process by which healthcare providers voluntarily report potential fraud or compliance violations to the OIG. The OIG’s Self-Disclosure Protocol may result in reduced penalties.
SSADMF (Social Security Administration Death Master File)
A database maintained by the Social Security Administration containing death records. Used in exclusion screening to identify deceased individuals who may still appear on active rosters.
Related Pages
How It Works
See our step-by-step screening process from enrollment to monthly reports.
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