OIG Exclusion List 101: Monthly Checks Every Provider Must Master
May 22, 2025
A quick-start guide to protecting your practice—and your paycheck—from costly sanctions.
1. What Is the OIG Exclusion List?
The Office of Inspector General (OIG) keeps a public database of individuals and entities barred from participating in federally funded healthcare programs (Medicare, Medicaid, some PPO contracts). Hiring or retaining someone on this list can trigger steep fines and claw-backs.
2. Why You Must Check Monthly
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Regulatory compliance. Most payer contracts—and Medicare rules—require monthly verification.
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Fraud prevention. Screening spots employees with prior healthcare fraud convictions or license revocations.
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Patient safety & reputation. Ensures only qualified team members handle PHI and billing.
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Liability control. If an excluded individual submits claims under your tax ID, you’re on the hook.
3. Who Needs to Be Screened?
| Must Check | Optional Check |
|---|---|
| Clinical staff (doctors, assistants, therapists) | Independent janitorial crews* |
| Billing & coding personnel | One-time contractors with no PHI access |
| Front-desk / schedulers with PHI access | |
| Owners & officers |
*Still use a basic confidentiality or nondisclosure agreement for after-hours vendors.
4. The Big Three Databases
| Database | URL | Frequency |
|---|---|---|
| OIG LEIE (List of Excluded Individuals/Entities) | exclusion.oig.hhs.gov | Monthly |
| SAM.gov exclusions | sam.gov | Monthly |
| State Medicaid/Payer lists | Varies by state | Monthly |
5. Step-by-Step: OIG Check in 2 Minutes
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Go to exclusion.oig.hhs.gov.
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Enter last name and first name.
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Review results.
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No Record → Pass.
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Potential Match → Click Verify and add DOB or NPI to confirm.
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Document outcome on your Exclusion-Check Log.
Repeat for SAM.gov and your state portal.
6. If You Find a Match
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Confirm identity with multiple data points (DOB, SSN, NPI).
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Remove the employee from federally funded duties immediately.
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Consult legal/compliance counsel about next steps and possible self-disclosure.
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Document everything—dates, decisions, and communications.
7. Best Practices for Bullet-Proof Compliance
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Verify three ways: OIG + SAM + state list.
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Log each search (employee, date, database, result). Keep records six years.
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Automate reminders. Put a recurring task on the first business day of every month.
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Onboard screening. Run checks before a new hire’s first day.
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Cross-train staff. Two people should know the process in case of vacations or turnover.
8. Quick Resources
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OIG LEIE Search Tool → exclusion.oig.hhs.gov
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SAM Exclusions → sam.gov
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State Medicaid Lists → Search “[Your State] OIG exclusion list”
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HIPAA & OIG Compliance Checklist → [Download]
9. Next Steps
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Add “Exclusion-Check Log” to your HIPAA/OIG manual.
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Run this month’s screenings today. It takes less than 10 minutes.
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Need a turnkey compliance system? Schedule a demo of Better HIPAA Blueprint and see automated logs, training modules, and customizable policies in action.
Consistent screening is simple, fast, and saves you from five-figure penalties—make it part of your monthly routine.
