Exclusion screening for ambulatory surgery centers

Why surgery centers are exposed

• Much of your OR team works for someone else. Surgeons hold privileges, anesthesia often comes from a contracted group, and techs may come through an agency. Contracting with an excluded person carries the same penalty as employing one: up to $24,947 per violation.
• Every case produces a facility claim. The ASC bills its own facility fee for each procedure, separate from the surgeon’s and anesthesia provider’s professional claims. Everyone in the room furnishes services behind that claim, though none of them appears on it by name.
• Privileging happens on a cycle, exclusions happen any month. A surgeon cleared at appointment can be excluded before reappointment comes around.
• Physician owners raise the stakes. If surgeons own shares in your center, an excluded owner faces a penalty of up to $24,947 per day, and OIG can exclude the center itself.

Who to screen

• Surgeons and proceduralists with privileges, whether or not they own shares
• Anesthesiologists, CRNAs, and every member of a contracted anesthesia group who works in your rooms
• OR, pre-op, and PACU nurses and surgical techs, including per diem, agency, and contracted staff
• Sterile processing technicians
• Schedulers, front desk, billers, coders, and outsourced billing staff
• Owners, investors, administrators, and management company staff

The group surgery centers forget most often is sterile processing. These techs never see a patient, so they rarely come up in credentialing. Their work is part of every case you bill, and OIG counts support work as “furnished.”

“I was so happy that I successfully uploaded everything for the first time on my own.”

Marta Twomey, RN, Interim Director of Nursing, Minimally Invasive Surgery of Hawaii

About 1,000 healthcare organizations trust us with their screening every month, including many surgery centers. Exclusion Screening was founded by former federal prosecutors Paul Weidenfeld and Robert Liles.

How we handle surgery center screening

• Monthly screening of your whole roster against the OIG LEIE, SAM, and all state Medicaid exclusion lists, including privileged physicians and contracted anesthesia and tech staff.
• Identity verification before anything is flagged. We confirm identity with Social Security number, date of birth, NPI, or license data before calling something a match.
• Our specialists resolve matches. When a name comes back, one of our trained specialists works it to a conclusion. Your medical staff coordinator doesn’t have to research possible hits.
• Dated records for every person, every month, ready when a surveyor or auditor asks to see your screening history, including for staff and providers who have left.

Plans start at $30 a month for up to 100 people. See pricing or schedule a demo.

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What the rules require of surgery centers

OIG’s Civil Monetary Penalties Law. A center that submits claims for items or services furnished by an excluded person is liable if it “knew or should have known” the person was excluded. A screen would have shown it, so not knowing is no defense. “Furnished” covers clinical, support, and administrative work, whether billed separately or bundled into the facility fee.

Contracting counts. An anesthesia group’s attestation doesn’t move the liability. If its CRNA is excluded and works your cases, your facility claims are at risk. The reasoning in your staffing agency’s screening is not your defense applies to anesthesia and tech contractors too. See also screening contractors and vendors.

Medical staff privileging. Medicare’s ASC Conditions for Coverage require you to grant medical staff privileges and to reappraise them periodically. An exclusion check belongs in that process, and monthly screening covers the time between reappraisals.

What it costs when screening fails

Our Beyond the Checkbox report doesn’t track surgery centers as their own sector. OIG’s settlement with Riverside Park SurgiCenter shows what one gap costs. The Florida center self-disclosed and still paid $192,415 for employing one excluded individual. OIG didn’t state the person’s role.

The bill has two parts. The civil money penalty can reach $24,947 per claim in 2026, and every claim tied to the excluded person’s work is an overpayment that must be repaid.

For staff who don’t bill, OIG’s Self-Disclosure Protocol estimates the overpayment as salary and benefits multiplied by your federal payer mix. A sterile processing tech costing $50,000 a year at a center where 60% of cases are Medicare or Medicaid works out to a $30,000 overpayment for each year of employment. For centers that self-disclose, OIG settlements generally start at a 1.5x multiplier. When the government or a whistleblower finds it first, the False Claims Act allows treble damages, and OIG is not bound by the proxy.

Common surgery center screening mistakes

1. Skipping privileged physicians. Surgeons who aren’t on your payroll still work your cases.
2. Taking the anesthesia group’s word for it. Get dated, per-person results each month, or screen the group’s providers yourself.
3. Checking only at privileging and reappointment. The months between reviews are when an exclusion goes unnoticed. More on why monthly screening matters.
4. Forgetting the people who never touch a patient. Sterile processing, schedulers, and billers furnish support work behind your facility claims.

A screening program for a surgery center

1. Build your rosters. Employees, privileged physicians, anesthesia providers, contractors, billing vendors, and owners. If you run more than one center, give each its own roster so it gets its own report. Centers are often audited one at a time.
2. Screen before the first case. Check the federal lists and the Medicaid list of every state where you bill.
3. Re-screen everyone monthly. Exclusion lists update monthly, so monthly is the floor.
4. Put screening in your contracts. Require anesthesia and staffing contractors to send provider lists and tell you about new people before they work.
5. Resolve every match the same week. Confirm identity, document the outcome, and pull the person from the schedule if the match is real.
6. Keep dated records. Store results per person, per month, including people who have left. See what to do if you have a confirmed exclusion. Centers tied to physician groups should also see exclusion screening for physician practices.

Questions surgery center compliance teams ask

Do we have to screen surgeons who have privileges but aren’t our employees?
Yes. Medicare and Medicaid won’t pay for items or services furnished at the medical direction of an excluded physician, and your facility fee for a case an excluded surgeon performs falls in that category. Whether or not they’re on your payroll, they work behind your claims. Screen privileged physicians monthly, along with your own staff, and keep the dated results with each physician’s credentialing file.

Our anesthesia group says it screens its CRNAs. Is that enough?
Only if you can show the records. Delegating the screening doesn’t delegate the liability, and an excluded CRNA working your cases puts your facility claims at risk. Ask the group for dated, per-person results each month, or get its full provider list, including fill-in and locum CRNAs, and screen it yourself.

Isn’t checking at credentialing and reappointment enough?
No. Exclusion lists update every month, and the “knew or should have known” standard means a check you could have run counts against you. A surgeon or CRNA can be excluded months after a clean review and keep working cases in your rooms. Monthly screening covers the time between privileging cycles.

What if we find an excluded person after they’ve worked cases?
Pull the person from the schedule right away, stop billing for affected services, and talk to counsel about OIG’s Self-Disclosure Protocol. Self-disclosure settlements generally start at a 1.5x multiplier on the overpayment, compared with up to treble damages if the government finds it first. Riverside Park SurgiCenter took the self-disclosure route and settled for $192,415.

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See SAFER Plus screen a surgery center roster: staff and privileged physicians, every state list, matches resolved by our specialists. Schedule a demo →