Exclusion screening for behavioral health and addiction treatment providers

Why behavioral health providers are exposed

• Lived experience is part of the workforce. Peer recovery specialists, and many counselors, are hired in part because of their own history with addiction. Some of that history includes criminal convictions. Federal law requires OIG to exclude people convicted of certain offenses, including felonies related to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances, for at least five years.
• Medicaid exclusions count on their own. In 2025 a New Hampshire counseling practice and its owner paid $300,000 to settle False Claims Act allegations that they billed Medicaid for services by someone excluded from the Medicaid program. A program that checks only the federal list can miss that person.
• Non-clinical staff cause the biggest bills. The $765,868 Ohio case involved an intake coordinator. A Utah recovery program paid $73,457 in 2025 for an excluded operations assistant. Neither person delivered therapy.
• Owners can lose the business. In 2023 the owner of a Maine substance abuse treatment program agreed to a five-year exclusion after continuing to employ an excluded individual, and paying her with MaineCare reimbursements, after an earlier settlement over the same person.

Who to screen

• Peer recovery specialists, peer support workers, and recovery coaches
• Licensed and certified counselors, therapists, and social workers, including interns working toward licensure
• Psychiatrists, psychiatric nurse practitioners, and other prescribers, including telehealth clinicians in other states
• Mental health technicians, residential aides, and house managers
• Nurses in detox, residential, and medication-assisted treatment programs
• Intake coordinators, case managers, site managers, billers, and operations staff
• Contracted clinicians and staffing agency placements
• Owners, board members, and managing employees

The group behavioral health providers forget most often is intake and operations staff. Riverside Recovery Services in Ohio paid $765,868 in 2022 for an excluded intake coordinator and site manager. In 2025 OIG excluded the company itself for defaulting on its payment obligations under that settlement.

“I appreciate your team’s speedy response to our requests!”

Audrey Jones, Office Coordinator, Vision Behavioral Health Services

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

How we handle behavioral health screening

• Monthly screening of your whole roster against the OIG LEIE, SAM, and all state Medicaid exclusion lists, including peers, interns, and part-time counselors who move between programs.
• Identity verification before anything is flagged. We confirm identity with Social Security number, date of birth, NPI, or license or certification data before calling something a match, so a common name on your peer roster doesn’t become a false alarm.
• Our specialists resolve matches. When a name comes back, one of our trained specialists works it to a conclusion. Your clinical director doesn’t get a list of possible hits to sort through between sessions.
• Dated records for every person, every month, ready when a state Medicaid auditor, a managed care plan, or OIG asks for your screening history, including for staff 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 behavioral health providers

OIG’s Civil Monetary Penalties Law. A provider 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. Not knowing is no defense, because a screen would have shown it. “Furnished” covers administrative and support work as well as therapy and counseling. That’s how an intake coordinator and an operations assistant each produced a penalty.

Mandatory exclusion follows certain convictions. Federal law requires OIG to exclude anyone convicted of a felony related to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance. Our articles on mandatory exclusion under section 1128(a)(4) and how long a mandatory exclusion lasts cover the details. A conviction alone doesn’t put someone on the list. What matters for screening is whether OIG or a state Medicaid program has excluded them, and that can happen after you hire them.

State certification is a separate question. A state board may certify a peer specialist or counselor who has a criminal record. That certification doesn’t lift a federal or state Medicaid exclusion. Your background check and your exclusion screen answer different questions, and you need both.

Exclusions don’t end on their own. When an exclusion period runs out, the person has to apply to OIG for reinstatement. Until OIG reinstates them, they’re still excluded. See applying for reinstatement.

What it costs when screening fails

Behavioral health providers paid $3,272,074 in exclusion-related penalties from 2020 through 2025, 10.8% of the $30.2 million total across all sectors, according to our Beyond the Checkbox analysis. The same report notes that Pennsylvania enforcement is concentrated in nonprofit human services, behavioral health agencies, and academic medical centers, with a focus on the Medicaid funding used for behavioral health and children’s care.

Recent OIG settlements with behavioral health providers:

Year	Provider	Excluded person’s role	Paid
2025	LifeWorks Counseling Associates, PLLC and its owner (New Hampshire)	Not stated (excluded from Medicaid)	$300,000 (False Claims Act settlement)
2025	Action Recovery Group (Utah)	Operations assistant	$73,457
2024	Region XII Commission on Mental Health and Retardation d/b/a Pine Belt Mental Healthcare Resources (Mississippi)	Not stated (two employees)	$43,030
2023	Long Island Center for Recovery (New York)	Therapeutic aide and registered nurse	$49,997
2022	Little Hills Healthcare d/b/a CenterPointe Hospital (Missouri)	Mental health technician	$55,453
2022	Riverside Recovery Services (Ohio)	Intake coordinator and site manager	$765,868

Sources: OIG enforcement actions (LifeWorks, Action Recovery Group, Pine Belt, Long Island Center for Recovery, CenterPointe, Riverside settlement). Also cited above: Riverside exclusion for default, Maine program owner’s exclusion, Arisa Health and Mid-South Health Systems. The LifeWorks case was resolved by the U.S. Attorney’s Office under the False Claims Act, and OIG’s notice describes the company as a telehealth provider.

The bill has two parts. The civil money penalty can reach $24,947 per claim in 2026. On top of that, every claim tied to the excluded person’s work is an overpayment that must be repaid. Behavioral health is billed session by session, so a counselor with a full Medicaid caseload generates hundreds of claims a year. For staff who don’t bill, such as an intake coordinator, OIG’s self-disclosure proxy multiplies salary and benefits by your federal payer mix.

Under OIG’s Self-Disclosure Protocol, settlements generally start at a 1.5x multiplier on the overpayment. When the government finds the problem first, the False Claims Act allows treble damages. The Riverside and Maine cases show the worst outcome: once the provider or its owner is excluded, Medicaid and Medicare revenue stops.

Common behavioral health screening mistakes

1. Treating a background check as an exclusion check. A criminal history report tells you about convictions. It doesn’t tell you whether OIG or a state Medicaid program has excluded the person. Run both.
2. Screening peers once at hire. A peer specialist with an old conviction may be cleared at hire and excluded later for a new one. Monthly screening catches the change.
3. Assuming an exclusion ended because the term did. Until OIG reinstates the person, they’re still excluded. Check the list, not the calendar.
4. Leaving out intake and operations staff. Riverside’s intake coordinator cost more than the other five cases in the table combined.
5. Skipping telehealth and contracted clinicians. A counselor seeing your clients by video from another state still furnishes services you bill, and needs that state’s Medicaid list checked too.

A screening program for a behavioral health provider

1. Build your rosters. Include every employee, intern, peer, contractor, and telehealth clinician, plus owners and managing employees. Add volunteers who do billable work. Give each site or program its own roster so it gets its own report. Sites and programs are often audited one at a time.
2. Screen before the first session. Check federal lists and the Medicaid list of every state where the person lives, is licensed or certified, or sees clients.
3. Re-screen everyone monthly. Treat monthly as the floor, especially for peer and residential staff.
4. Resolve every match the same week. Confirm identity, document the outcome, and pull the person from billable work if the match is real.
5. Keep dated records. Store results per person, per month, including people who have left. Managed care plans and state auditors ask for them.
6. Have a response plan. Stop billing for the person’s services, call counsel, and evaluate self-disclosure. Don’t keep the person on payroll from Medicaid funds while you decide; that’s what led to the Maine owner’s exclusion.

More on structure: building a compliance program and who must be screened.

Questions behavioral health compliance teams ask

Can we hire a peer recovery specialist with a drug conviction?
A conviction alone doesn’t bar federal program billing. An exclusion does. Before hire, screen the person against the OIG list, SAM, and the state Medicaid lists. If they aren’t excluded, the hiring decision is yours and your state certification board’s. Keep screening monthly, because a conviction can lead to an exclusion after the person starts.

Someone’s exclusion period ended last year. Can they work for us now?
Only if OIG has reinstated them. An exclusion doesn’t lapse when the term runs out; the person has to apply for reinstatement and be approved. Check the current OIG list and state lists before hire, and keep the dated result in the file.

Our counselors are licensed by the state. Doesn’t that cover it?
No. A state license or certification and a federal or state Medicaid exclusion are separate decisions by separate agencies. A licensed counselor can still be excluded. The LifeWorks settlement involved someone excluded from Medicaid, which a license check would not show.

Do we need to screen staff who never bill, such as intake or house managers?
Yes. “Furnished” includes administrative and support work tied to claims. Two of the cases in our table, Riverside Recovery Services and Action Recovery Group, involved non-clinical staff. OIG calculates the overpayment for these roles from salary and benefits, so it adds up even without a single billed session.

What happens if we find an excluded staff member?
Remove the person from billable work right away, stop billing for their services, and talk to counsel about OIG’s Self-Disclosure Protocol. Self-disclosure settlements generally start at a 1.5x multiplier, compared with up to treble damages if the government finds it first. Keeping the person on staff after you know is how a Maine program owner ended up excluded.

Do you work with county and regional mental health agencies?
Yes. Public agencies have the same exposure, and some settlements in this sector involved county or regional bodies. See our page for government and public entities. Inpatient psychiatric programs inside hospitals are covered on our hospitals page.

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