Updated OIG updated its Self-Disclosure Protocol in October 2026. What it means if you find an excluded person. Read the guide →

Who must be screened for OIG exclusions

If your organization bills Medicare, Medicaid, or another federal health care program, screen every person and company whose work feeds into an item or service those programs pay for. That means employees (clinical and non-clinical), per diem staff, volunteers, contractors, staffing agency placements, owners and managing employees, board members, and billing vendors. Screen each one before they start, then every month, against the OIG list, SAM, and every state Medicaid exclusion list.

OIG’s test looks at the work a person does. Job title and pay status don’t decide it. This guide covers where the test comes from and who it puts on your roster.

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The legal basis for exclusion screening

Three federal sources do the work. Together they make screening the only practical defense.

The payment ban. Under 42 CFR 1001.1901(b), Medicare (including Medicare Advantage and Part D), Medicaid, and every other federal health care program will not pay for any item or service furnished by an excluded individual or entity. The ban also covers items and services furnished “at the medical direction or on the prescription of” an excluded clinician, when the provider knew or had reason to know of the exclusion.

The penalty for arranging or contracting. The Civil Monetary Penalties Law, 42 U.S.C. 1320a-7a(a)(6), lets OIG penalize anyone who “arranges or contracts (by employment or otherwise)” with a person they “know or should know” is excluded, for items or services payable by a federal program. “Should know” carries the weight. The LEIE is public and free, so an exclusion you could have found is one you should have known about. In 2026 the penalty is up to $24,947 per item or service, plus an assessment of up to three times the amount claimed and possible exclusion of your organization. Separately, every claim tied to the excluded person is an overpayment you must repay.

OIG’s 2013 Special Advisory Bulletin. The Updated Special Advisory Bulletin on the Effect of Exclusion (May 8, 2013) explains how far the ban reaches. Three points shape every roster:

  • Administrative and management work counts. Excluded people may not furnish “administrative and management services that are payable by the Federal health care programs,” even when those services aren’t billed separately. OIG names executive roles (CEO, CFO, general counsel, HR director, practice office manager) and support work like health IT, billing and accounting, staff training, and HR, “unless wholly unrelated to Federal health care programs.”
  • Bundled payment hides nothing. The ban applies to itemized claims, cost reports, DRGs, capitated rates, and every other payment method.
  • Pay status doesn’t matter. An excluded person may not provide payable services “regardless of whether the person is an employee, a contractor, or a volunteer or has any other relationship with the provider.”

Not technically required, but practically required

Here’s the plain version. No federal statute or regulation tells most providers, in those words, to check the exclusion lists. OIG’s 2013 bulletin says so itself. But the government expects you to screen, and the law is built so that skipping it costs you:

  • Federal programs won’t pay for work done by an excluded person, so every affected claim becomes an overpayment you owe back.
  • If you “knew or should have known” the person was excluded, OIG can add civil money penalties. The lists are public and free to search, so a check you could have run is evidence that you should have known. That’s a high bar.
  • Many organizations also have a direct mandate in a state Medicaid provider agreement, a Medicare Advantage contract, a Corporate Integrity Agreement, or a Condition of Participation. Those are covered below.

We treat the expectation as the requirement, and we recommend you do the same.

For more background, see our legal guide to OIG exclusions and The Definitive Guide to OIG Exclusions.

Who to screen

OIG tells providers to review each job category and each contract and ask whether the item or service is “directly or indirectly, in whole or in part, payable by a Federal health care program.” If yes, screen everyone in that category or under that contract. Apply the same test to contractors, subcontractors, and contractors’ employees.

Employees, clinical and non-clinical

Physicians, nurses, therapists, aides, and pharmacists are the obvious group. The people who never see a patient belong on the roster too. CMS’s 2009 letter to state Medicaid directors lists excluded administrators, billing agents, accountants, claims processors, utilization reviewers, ambulance dispatchers, and staff who prepare surgical trays among those whose services Medicaid can’t pay for. In practice, screen the whole workforce.

Per diem, PRN, and temporary staff

Hours worked don’t change the analysis. A nurse who works two shifts a month furnishes the same payable services as a full-time nurse. Add per diem, PRN, seasonal, and temporary workers before their first shift and keep them on while they can be scheduled.

Volunteers

OIG’s bulletin names volunteers and gives the example of an excluded health care professional volunteering at a hospital or nursing home. If a volunteer’s work supports federally paid care, an exclusion creates the same exposure as it would for an employee.

Contractors and vendors

Independent contractors, consultants, locum tenens physicians, contracted therapists, medical directors, and vendors whose work touches federally paid care all go on the roster. OIG specifically recommends screening physician groups that cover emergency departments and billing or coding contractors. Screen entity vendors by company name, and decide whether you’ll screen the people a contractor sends or rely on the contractor and verify its work. See screening contractors and vendors.

Staffing agency placements

This is OIG’s own example. If a hospital uses a staffing agency for temporary or per diem nurses and an excluded nurse from that agency treats federal program patients, the hospital faces overpayment liability and possible CMP liability. You may rely on the agency’s screening, but OIG says to verify it by “requesting and maintaining screening documentation from the contractor.” Reasonable reliance may reduce the CMP. The overpayment stays with you either way. Screen placements yourself, or hold dated per-person results every month. See why a staffing agency’s screening is not your defense and exclusion screening for staffing agencies.

Entities furnishing services under arrangement

OIG applies the payment ban to excluded people who “work for or under an arrangement with” a hospital, nursing home, home health agency, or managed care entity. Screen the entity and the people it sends. Some Conditions of Participation say so directly. A home health agency’s under-arrangement partners may not have been excluded from any federal health care program (42 CFR 484.105(e)(2)).

Owners, officers, managing employees, and board members

An excluded person may be penalized for holding an ownership or control interest, or for serving as an officer or managing employee, in a participating entity (42 U.S.C. 1320a-7a(a)(4)). OIG adds that if an excluded owner takes part in billing or management, “both the owner and the provider will risk CMPL liability.” State Medicaid agencies must check the exclusion status of providers’ owners, agents, and managing employees under 42 CFR 455.436.

Screen owners with a 5% or greater stake, officers, directors, managing employees, and board members. CMS requires Medicare Advantage and Part D sponsors to screen governing body members, and a provider’s board makes the leadership decisions OIG’s bulletin describes.

Referring, ordering, and prescribing clinicians

This group needs precision.

  • A referral alone doesn’t taint your claim. OIG says an excluded provider may refer a patient to a non-excluded provider, whose services remain payable, as long as the excluded provider doesn’t furnish, order, or prescribe anything for that patient.
  • Orders and prescriptions do. Under 42 CFR 1001.1901(b)(1)(ii), items or services furnished on an excluded clinician’s order or prescription aren’t payable if you knew or had reason to know. OIG says labs, imaging centers, DME suppliers, and pharmacies “should ensure, at the point of service, that the ordering or prescribing physician is not excluded.”
  • Who pays the penalty. The CMP for ordering or prescribing while excluded (42 CFR 1003.200(b)(6)) falls on the excluded orderer. For the lab or pharmacy that filled the order, the risk is non-payment and an overpayment to repay. OIG also warns that relying on Part D plans or state edits to catch excluded prescribers may still leave you responsible.

If you fill outside orders, screen your ordering and prescribing panel monthly. See our pages for pharmacies and laboratories.

Billing companies

OIG names billing and coding contractors as a group providers should screen. If you’re a provider, put your billing company on your vendor roster and ask for proof that it screens its staff.

If you run a billing company, your obligation is your own staff. Your coders and billers do the administrative work behind your clients’ federal claims, so an excluded biller can turn those claims into overpayments. You aren’t required to screen your clients’ employees. Many billing companies offer that as a service, and we can run it under your brand. See exclusion screening for medical billing companies.

Who you generally don’t have to screen

OIG’s bulletin draws the line: if federal health care programs “do not pay, directly or indirectly, for the items or services being provided by the excluded individual,” a participating provider may employ or contract with that person. A provider may also use an excluded person to serve only non-federal patients, as long as no federal claims are submitted for that work.

So a vendor whose goods or services have no connection to federally paid care can come off the roster. Two cautions first. “Indirectly” covers a lot: CMS’s 2009 letter says the ban reaches administrative services and salaries reported on a cost report. And OIG’s administrative carve-out is limited to work “wholly unrelated” to federal programs, which describes very little at a provider that bills them. If you can’t say with confidence that a vendor’s work is outside federal payment, screen it.

State Medicaid requirements

In January 2009, CMS sent state Medicaid directors SMDL #09-001. It told states to advise providers of their obligation “to screen all employees and contractors,” to make that a condition of enrollment, to “require providers to search the HHS-OIG website monthly,” and to require prompt reporting of any exclusion found. States with their own exclusion lists were told to remind providers to search them whenever they search the LEIE.

States also screen providers directly. Under 42 CFR 455.436, the state Medicaid agency must confirm the exclusion status of enrolled providers and their owners, agents, and managing employees, checking the LEIE and the federal debarment list “no less frequently than monthly.” OIG notes that this rule doesn’t itself make states require monthly provider screening of staff. CMS recommended that states consider it.

Read your state provider agreement and any Medicaid managed care contracts. They often hold the most specific requirement you’re bound by. See our state Medicaid exclusion database guide and Medicare and Medicaid screening compliance.

Medicare Advantage and Part D: first tier, downstream, and related entities

CMS’s Medicare Managed Care Manual, Chapter 21, §50.6.8 says sponsors must review the LEIE and the GSA exclusion list (now SAM) “prior to the hiring or contracting of any new employee, temporary employee, volunteer, consultant, governing body member, or FDR, and monthly thereafter.” FDRs are the first tier, downstream, and related entities doing work under the sponsor’s Medicare contract. If you’re one, such as a contracted provider group, pharmacy benefit manager, or billing vendor, expect your plan contracts to require monthly screening and proof of it. Plans should see exclusion screening for health plans.

How often to screen

Screen before hire or contract, then monthly.

OIG says providers “should check the LEIE prior to employing or contracting with persons.” After that, because OIG updates the LEIE monthly, “screening employees and contractors each month best minimizes potential overpayment and CMP liability.” CMS asked states to require monthly searches in 2009 and requires monthly screening of Medicare Advantage and Part D sponsors.

Monthly matters because many exclusions happen after hire. A nurse who was clean at onboarding can lose a license or plead to a fraud charge and land on a list a year later. Each unchecked month is a month of claims you may have to repay. See why monthly screening matters.

Which lists to screen

  • OIG’s LEIE. OIG calls it the primary source for exclusion screening. It’s updated monthly and includes date of birth and occupation at exclusion. See the OIG exclusion list.
  • SAM.gov. Carries OIG exclusions plus debarments by other federal agencies. Both CMS’s MA manual and 42 CFR 455.436 name it. See our SAM explainer.
  • State Medicaid exclusion lists. 43 states plus the District of Columbia keep their own lists, and two states keep two, so there are 46 state lists. With the LEIE and SAM, that’s 48 databases. A person can be excluded by a state without appearing on the LEIE. Screen every state list, because people move and many organizations bill more than one state. See why we screen every state exclusion list.

Build a roster per site, department, or client

Give each site, department, or client its own roster and its own report. Surveyors, auditors, and payers usually review one location or one contract at a time. When they ask for a facility’s screening history, you want a dated monthly report for that facility that you can hand over as is. Separate rosters also make gaps visible, such as a clinic added in an acquisition. Staffing agencies should split rosters by client.

Summary: who, why, and how often

Who Why they’re in scope How often
Employees, clinical and non-clinical Payment ban covers direct care and administrative work (42 CFR 1001.1901; 2013 SAB) Before hire, then monthly
Per diem, PRN, temporary staff Same services, same ban Before first shift, then monthly
Volunteers Named in the 2013 SAB Before start, then monthly
Contractors and vendors tied to federally paid work CMP for arranging or contracting (1320a-7a(a)(6)) Before contract, then monthly
Staffing agency placements SAB example; overpayment stays with you Before first shift, then monthly
Under-arrangement entities Ban covers work under arrangement; some CoPs require it Before contract, then monthly
Owners, officers, managing employees, board members CMP on excluded owners and managers (1320a-7a(a)(4)); state checks (455.436) Before appointment, then monthly
Ordering and prescribing clinicians Their orders aren’t payable (1001.1901(b)(1)(ii)) At point of service; panel monthly
Billing companies (as your vendor) SAB names billing and coding contractors Before contract, then monthly
Vendors with no tie to federally paid work Generally outside the CMP Screen if in doubt

Putting it into practice

  1. Inventory every relationship. Pull lists from HR, payroll, volunteer services, medical staff, contracting, and accounts payable.
  2. Build rosters by site, department, or client.
  3. Screen before the start date, then monthly, against federal lists and every state Medicaid list.
  4. Confirm identity before you act, using Social Security number, date of birth, NPI, or license number, and record how each match was resolved.
  5. Keep dated records per person, per month, including people who have left.
  6. Have a response plan. On a confirmed exclusion, remove the person from federally paid work, stop billing for their services, and talk to counsel about OIG’s Self-Disclosure Protocol. Settlements under the protocol generally start at 1.5x the overpayment, compared with up to treble damages under the False Claims Act.

More on structure: building a compliance program.

How we handle it

About 1,000 healthcare organizations trust us with their screening every month. We screen employees, contractors, volunteers, vendors, and board members against all 48 databases. We verify identity before anything is flagged, our specialists resolve potential matches, and every roster gets its own dated monthly report. Exclusion Screening was founded by former federal prosecutors Paul Weidenfeld and Robert Liles.

Start with our sectors overview, or go to hospitals, nursing facilities, staffing agencies, or medical billing companies.

Frequently asked questions

Is exclusion screening required by law?
Not technically, but practically, yes. No federal rule tells most providers in those words to check the lists. The government still expects it: it won’t pay for work by excluded people, and the “knew or should have known” standard means a public list you didn’t check counts against you. Many organizations also have a direct mandate through state Medicaid agreements, Medicare Advantage contracts, or Corporate Integrity Agreements. Treat the expectation as the requirement.

Do we need to screen staff who never touch patient care?
Almost always. OIG says the ban covers administrative and management services, including billing, IT, HR, training, and executive roles, unless the work is wholly unrelated to federal programs. Bundled and cost-reported payments count. An excluded office manager can create the same exposure as an excluded clinician.

Can we rely on our staffing agency or contractor to screen?
You can, but the risk stays with you. OIG says to verify by requesting and keeping the contractor’s screening documentation. Reasonable reliance may reduce a penalty. It doesn’t affect the overpayment, which you repay no matter who missed the exclusion.

Do we have to screen physicians who refer patients to us?
A referral alone doesn’t make your claim unpayable. Orders and prescriptions do: if you furnish items or services on an excluded clinician’s order and knew or had reason to know, federal programs won’t pay. Labs, pharmacies, imaging centers, and DME suppliers should screen their ordering and prescribing clinicians.

Is screening the OIG list enough?
No. A person can be excluded by a state Medicaid program without appearing on the LEIE. We screen 48 databases: the LEIE, SAM, and 46 state lists kept by 43 states and the District of Columbia. CMS told states with their own lists to remind providers to search them alongside the LEIE.

Should we keep one roster for the whole organization?
We recommend a roster for each site, department, or client, each with its own report. Auditors and payers usually review one location or contract at a time, and a per-site report answers their request directly.

See how we screen every roster, every month, against all 48 databases, with matches resolved by our specialists. Schedule a demo →

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