Exclusion screening for home health agencies
Home health agencies have paid $2.3 million in exclusion-related penalties since 2020, and most of those cases share one detail: the excluded person was a home health aide on the agency’s own payroll. We screen your aides, nurses, therapists, and contractors every month against the federal exclusion lists and every state Medicaid list, and our specialists resolve any match before it reaches you.
Why home health agencies are exposed
- Aides are the most-penalized role. In OIG’s home health settlements since 2020, the excluded worker is most often a home health aide or personal care attendant. These are high-turnover, hard-to-fill roles, and the people in them often move between agencies.
- CMS can act on its own. Since January 2018, the home health Conditions of Participation require you to make sure anyone furnishing services under arrangement has not been excluded. That gives CMS its own enforcement path, up to termination, separate from OIG’s penalties.
- Most home health agencies bill Medicaid as well as Medicare. A worker can be excluded by a state Medicaid program without appearing on the federal OIG list. Screening only the federal lists leaves that gap open.
- OIG has excluded an entire agency. In 2015, OIG excluded an Illinois home health agency from all federal health care programs for three years because it employed an excluded nurse and billed for her services.
Who to screen
- Home health aides and personal care attendants, including per diem and PRN staff
- RNs, LPNs, case managers, and clinical supervisors
- Physical, occupational, and speech therapists, whether employed or contracted
- Office staff, schedulers, billers, and intake coordinators
- Staffing agency placements and any entity furnishing services under arrangement
- Owners, administrators, and managing employees
The group agencies forget most often is office staff. In 2024 an agency paid $377,773 and its owner accepted a 20-year exclusion. The excluded person in that case was the agency’s office manager.
“Wow! You guys are fast. I just received the results.”
Ryann Heber, Amicable Healthcare, Inc.
About 1,000 healthcare organizations trust us with their screening every month, including many home health agencies. Exclusion Screening was founded by former federal prosecutors Paul Weidenfeld and Robert Liles, and we are a member of the Home Care Association of America.
How we handle home health screening
- Monthly screening of your whole roster against the OIG LEIE, SAM, and all state Medicaid exclusion lists, not only the states where you’re licensed.
- Identity verification before anything is flagged. Aide rosters have plenty of common names, so 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. We don’t hand you a list of possible hits to sort out yourself.
- Dated records for every person, every month, ready when a surveyor or auditor asks to see 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.
What the rules require of home health agencies
Two separate authorities apply to an agency that bills federal programs.
OIG’s Civil Monetary Penalties Law. An organization 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 not a defense, because a screen would have shown it. “Furnished” covers more than hands-on care: administrative and support work that sits behind a claim counts too. That’s why office staff belong on your screening roster.
CMS’s Conditions of Participation. Under the HHA Conditions of Participation that took effect January 13, 2018, agencies must make sure that anyone furnishing services under arrangement has not been excluded or terminated from Medicare, Medicaid, or any federal health care program, denied Medicare or Medicaid enrollment, had billing privileges revoked, or been debarred from any government program. Because this is a Condition of Participation, a failure is a survey and certification issue as well as a penalty issue. Our co-founder Paul Weidenfeld wrote about what the 2017 final rule changed for home health.
Neither authority lets you hand the obligation to someone else. A staffing agency can run screens for you, but if its screen misses an excluded aide, the penalty still lands on the agency that billed. We cover this in detail in why your staffing agency’s screening is not your defense.
What it costs when screening fails
Home health agencies paid $2,298,889 in exclusion-related penalties from 2020 through 2025, 7.6% of the $30.2 million total across all sectors, according to our Beyond the Checkbox analysis.
Recent OIG settlements with home health agencies:
| Year | Agency | Excluded person’s role | Paid |
|---|---|---|---|
| 2025 | CareLink Home Health (Illinois) | Nurse and case manager | $35,597 |
| 2025 | AccuCare Home Health Services (Arizona) | Home health aide | $20,000 |
| 2024 | Independence Home Healthcare (California) | Office manager | $377,774, plus a 20-year exclusion for the agency and its owner |
| 2023 | Advent Home Health (Nevada) | Not stated (self-disclosed) | $263,993 |
| 2023 | Professional Home Health Care 2 (Ohio) | Home health aide | $77,486 |
| 2022 | Serenity Home Healthcare Services (Ohio) | Home health aide | $146,952 |
Sources: OIG enforcement actions (CareLink, AccuCare, Independence, Advent, Serenity, Professional 2). The Independence settlement also resolved allegations of improper remuneration.
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. An aide who makes several visits a week for a year can touch hundreds of claims.
How the problem comes to light changes the math. Under OIG’s Self-Disclosure Protocol, settlements generally start at a 1.5x multiplier on the overpayment. When the government finds it first, the False Claims Act allows treble damages. In the Illinois case, OIG went further and excluded the agency itself, which ends Medicare and Medicaid revenue for the length of the exclusion (our write-up).
Common home health screening mistakes
- Screening at hire and not again. People are added to exclusion lists every month. An aide who was clean in March can be excluded in July and keep working visits.
- Federal lists only. If you bill Medicaid, a state-only exclusion still creates liability. Penalties for missed state exclusions have grown from five figures in 2020 to $450,000–$860,000 in recent cases.
- Leaving out non-clinical staff. The Independence case shows an office manager can cost as much as a clinician.
- Trusting a staffing agency’s attestation. “We screen our people” is a promise, not a record. If you can’t produce dated results for each placement, you can’t show you met the “should have known” standard.
- Closing name matches as “probably not them.” A match needs identity confirmation with Social Security number, date of birth, license, or NPI, and a written record of how it was resolved.
A screening program for a home health agency
- Build your rosters. Include every employee, per diem worker, contractor, staffing placement, and under-arrangement entity, plus owners and managing employees. Give each branch its own roster so it gets its own report. Branches are often audited one at a time.
- Screen before the first visit. Check federal lists and the Medicaid list of every state where the person will work or where you bill.
- Re-screen everyone monthly. Treat monthly as the floor.
- Resolve every match the same week. Confirm identity, document the outcome, and pull the person from billable work if the match is real.
- Keep dated records. Store results per person, per month, in your own files, including people who have left.
- Have a response plan. If you find a confirmed exclusion, stop billing for that person’s services, call counsel, and evaluate self-disclosure.
More on structure: building a compliance program and who must be screened.
Questions home health compliance teams ask
Do we have to screen aides we get through a staffing agency?
Yes. Delegating the screening doesn’t delegate the liability. If an excluded aide furnishes services you bill to Medicare or Medicaid, the penalty falls on your agency. Ask the staffing agency for dated, per-person screening results, or screen the placements yourself every month.
How often should a home health agency screen?
Monthly, plus before anyone’s first visit. Exclusion lists update monthly, and the “knew or should have known” standard means a check you could have run but didn’t counts against you. A single screen at hire leaves every month after it uncovered.
We mostly bill Medicare. Do state Medicaid lists matter?
If you bill Medicaid in any state, yes. A person can be excluded by a state Medicaid program without appearing on the federal OIG list. Our co-founder’s analysis of the 2017 home health rule notes that CMS can hold an agency responsible for a state exclusion as well as a federal one.
What will a surveyor or auditor want to see?
Dated screening results for each person for each month they worked, including former staff, and a record of how every potential match was resolved. A policy that says you screen monthly isn’t enough without the results behind it.
What do we do if we find an excluded aide on staff?
Remove the person from billable work right away, stop billing for their services, and talk to counsel about OIG’s Self-Disclosure Protocol. Under the protocol, settlements generally start at a 1.5x multiplier on the overpayment, compared with up to treble damages under the False Claims Act if the government finds it first.
Do you screen home care (non-medical) staff too?
Yes. Many of our customers run both home health and private-duty or personal care lines. See exclusion screening for home care agencies.
See SAFER Plus screen a home health roster: every aide, every state list, matches resolved by our specialists. Schedule a demo →