It’s time for smarter exclusion monitoring.
We deliver healthcare’s most trusted ongoing OIG exclusion monitoring and state Medicaid exclusion monitoring for every population.
Here’s what you need to know about OIG exclusion monitoring.
We deliver automated ongoing OIG exclusion monitoring for every population across all federal and state lists.
The Law
In accordance with Sections 1128 and 1156 of the Social Security Act, HHS OIG mandates that healthcare organizations do not hire or do business with “excluded or sanctioned” individuals or entities.
Providers who participate in federal healthcare programs must monitor federal and state exclusion sources to avoid fines and penalties.
State Reporting
Performance Standard 8(f) requires all states to report pertinent information on the Medicaid Fraud Control Unit (MFCU) convictions to OIG within 30 days of sentencing. In 2018, the average time for a state exclusion to make it to the OIG LEIE was 173 days.
Today, 42 states publish exclusion records, but each state updates at different times and in multiple data formats, making it difficult to keep track of excluded providers from each state.
Fines and Penalties
Civil Monetary Penalties enforced by the HHS Office of Inspector General (OIG) or False Claim allegations by the U.S. Department of Justice (DOJ) can result in more than $20,000 per false claim or statement, plus treble damages.
The average penalty for employing or contracting an excluded person in 2018 was
$126,738. Read the latest published Civil Monetary Penalties.
Exclusion Sources
Today, there are two federal exclusion sources (OIG LEIE and GSA/SAM) and 42 state Medicaid Exclusion/Terminated Provider Lists. Federal and state exclusion lists combined contain more than 200,000 individuals or entities.
The complexity of finding, managing, and analyzing inefficient and incomplete government data creates compliance and financial risk for your organization if you are not utilizing an effective automated monitoring solution. Our team provides you with data confidence and support each step of the way.
Healthcare Exclusion Data
We’ve made it easy to see the risk of healthcare exclusions across the country.Each month, we update our Exclusion Map with data from all federal and state exclusion or terminated provider lists.
Discover each state’s metrics by clicking on the interactive map.
Alabama Exclusion Data
Total Exclusions: 1,894
Source: Alabama Exclusion List
Format: Electronic
Update Schedule: Monthly
Alaska Exclusion Data
Total Exclusions: 275
Source: Alaska Exclusion List
Format: Electronic
Update Schedule: Monthly
Arizona Exclusion Data
Source: Arizona Exclusion List
Format:
Update Schedule: List No Longer Maintained
Arkansas Exclusion Data
Total Exclusions: 1,325
Source: Arkansas Exclusion List
Format: Electronic
Update Schedule: Monthly
California Exclusion Data
Total Exclusions: 19,321
Source: California Exclusion List
Format: Electronic
Update Schedule: Monthly
Colorado Exclusion Data
Total Exclusions: 177
Source: Email Request Only
Format: Electronic
Update Schedule: Monthly
Connecticut Exclusion Data
Total Exclusions: 50
Source: Connecticut Exclusion List
Format: Electronic
Update Schedule: Monthly
Delaware Exclusion Data
Total Exclusions: 268
Source: Email Request Only
Format: Electronic
Update Schedule: Monthly
District of Columbia Exclusion Data
Total Exclusions: 15
Source: District of Columbia Exclusion List
Format: Electronic
Update Schedule: Monthly
Florida Exclusion Data
Total Exclusions: 1,331
Source: Florida Exclusion List
Format: Electronic
Update Schedule: Monthly
Georgia Exclusion Data
Total Exclusions: 1,214
Source: Georgia Exclusion List
Format: Electronic
Update Schedule: Monthly
Hawaii Exclusion Data
Total Exclusions: 208
Source: Hawaii Exclusion List
Format: Electronic
Update Schedule: Monthly
Idaho Exclusion Data
Total Exclusions: 135
Source: Idaho Exclusion List
Format: Electronic
Update Schedule: Monthly
Illinois Exclusion Data
Total Exclusions: 2,440
Source: Illinois Exclusion List
Format: Electronic
Update Schedule: Monthly
Indiana Exclusion Data
Total Exclusions: 88
Source: Indiana Exclusion List
Format: Electronic
Update Schedule: Monthly
Iowa Exclusion Data
Total Exclusions: 682
Source: Iowa Exclusion List
Format: Electronic
Update Schedule: Monthly
Kansas Exclusion Data
Total Exclusions: 56
Source: Kansas Exclusion List
Format: Electronic
Update Schedule: Monthly
Kentucky Exclusion Data
Total Exclusions: 202
Source: Kentucky Exclusion List
Format: Electronic
Update Schedule: Monthly
Louisiana Exclusion Data
Total Exclusions: 4,405
Source: Louisiana Exclusion List
Format: Electronic
Update Schedule: Monthly
Maine Exclusion Data
Total Exclusions: 980
Source: Maine Exclusion List
Format: Electronic
Update Schedule: Monthly
Maryland Exclusion Data
Total Exclusions: 1,498
Source: Maryland Exclusion List
Format: Electronic
Update Schedule: Monthly
Massachusetts Exclusion Data
Total Exclusions: 196
Source: Massachusetts Exclusion List
Format: Electronic
Update Schedule: Monthly
Michigan Exclusion Data
Total Exclusions: 2,606
Source: Michigan Exclusion List
Format: Electronic
Update Schedule: Monthly
Minnesota Exclusion Data
Total Exclusions: 1,118
Source: Minnesota Exclusion List
Format: Electronic
Update Schedule: Monthly
Mississippi Exclusion Data
Total Exclusions: 164
Source: Mississippi Exclusion List
Format: Electronic
Update Schedule: Monthly
Missouri Exclusion Data
Total Exclusions: 181
Source: Missouri Exclusion List
Format: Electronic
Update Schedule: Monthly
Montana Exclusion Data
Total Exclusions: 119
Source: Montana Exclusion List
Format: Electronic
Update Schedule: Monthly
Nebraska Exclusion Data
Total Exclusions: 1,021
Source: Nebraska Exclusion List
Format: Electronic
Update Schedule: Monthly
Nevada Exclusion Data
Total Exclusions: 634
Source: Nevada Exclusion List
Format: Electronic
Update Schedule: Monthly
New Hampshire Exclusion Data
Total Exclusions: 47
Source: New Hampshire Exclusion List
Format: Electronic
Update Schedule: Monthly
New Jersey Exclusion Data
Total Exclusions: 3,789
Source: New Jersey Exclusion List
Format: Electronic
Update Schedule: Monthly
New York Exclusion Data
Total Exclusions: 7,445
Source: New York Exclusion List
Format: Electronic
Update Schedule: Monthly
North Carolina Exclusion Data
Total Exclusions: 63
Source: North Carolina Exclusion List
Format: Electronic
Update Schedule: Monthly
North Dakota Exclusion Data
Total Exclusions: 147
Source: North Dakota Exclusion List
Format: Electronic
Update Schedule: Monthly
Ohio Exclusion Data
Total Exclusions: 1,565
Source: Ohio Exclusion List
Format: Electronic
Update Schedule: Monthly
Pennsylvania Exclusion Data
Total Exclusions: 5,244
Source: Pennsylvania Exclusion List
Format: Electronic
Update Schedule: Monthly
South Carolina Exclusion Data
Total Exclusions: 847
Source: South Carolina Exclusion List
Format: Electronic
Update Schedule: Monthly
Tennessee Exclusion Data
Total Exclusions: 15
Source: Tennessee Exclusion List
Format: Electronic
Update Schedule: Monthly
Texas Exclusion Data
Total Exclusions: 10,791
Source: Texas Exclusion List
Format: Electronic
Update Schedule: Monthly
Vermont Exclusion Data
Total Exclusions: 51
Source: Vermont Exclusion List
Format: Electronic
Update Schedule: Monthly
Washington Exclusion Data
Total Exclusions: 222
Source: Washington Exclusion List
Format: Electronic
Update Schedule: Monthly
West Virginia Exclusion Data
Total Exclusions: 92
Source: West Virginia Exclusion List
Format: Electronic
Update Schedule: Monthly
Wyoming Exclusion Data
Total Exclusions: 105
Source: Wyoming Exclusion List
Format: Electronic
Update Schedule: Monthly
HHS OIG LEIE
Total Exclusions: 74,299
SAM.gov Database
Total Exclusions: 70,457
State Exclusion Data
Total Exclusions: 73,055
What makes our exclusion monitoring smarter than anyone else's?
Fully Automated Ongoing Exclusion Monitoring
Our exclusion monitoring solution is fully automated, screening your employees, providers, and vendors against every state and federal exclusion source every single day. We screen every individual or entity across the OIG LEIE, SAM/GSA and all 42 state Medicaid exclusion lists continuously to ensure we catch every exclusion as quickly as possible to power critical business processes and keep people safe.
Exact-Match Verification. No More False-Positives.
No more false positives or potential exclusion results. Our best-in-class monitoring science verifies every potential exclusion result on a continuous basis, delivering you exact-matches – confirmed, actionable results to empower faster, more informed decisions about provider and employee eligibility.
Even Better Than the Primary Source
We enrich both primary source data and our client’s data records with identifiers to catch and verify issues no one else can, alerting you to issues you would never otherwise find. From the beginning, we set out to do healthcare monitoring better than anyone else. This meant we had to aggregate, clean, and enrich primary source data until our proprietary dataset was smarter than the original sources.
Reduce Your Organizational Risk
You never know when a compliance issue could strike, and timeliness is crucial. Monitor all federal and state exclusion lists in real-time and be alerted if anything needs your attention. A comprehensive solution allows your organization to avoid false claims, corporate integrity agreements, and more. Our solution records and reports every OIG and state Medicaid exclusion within your populations and is always audit and survey-ready. And for extra peace of mind, we guarantee our work with a $5 million E&O Policy.
Seamless Integrations Designed to Scale
We’ve designed flexible exclusion monitoring solutions to integrate into your existing workflows, both within our software suite and through our powerful APIs. Enterprise healthcare organizations integrate our solution into their systems of record, such as an HRIS, referral management software, or a claims processing system.
An Award-Winning Client Success Team
Our team combines advanced technology with human experts to keep you compliant, safe and efficient. We keep our clients updated with innovations, organizational reports, and ProviderTrust Insights about your monitored populations and risk. Don’t settle for less from other vendors. We value relationships and creating better, safer healthcare with a dedicated Client Success team.
Six Tips for Navigating Continuous Change
As organizations work to adapt to a quickly changing market, some processes and behaviors will be altered for the long term, and some will continue to adapt. Get the tip sheet to learn more.
OIG Exclusion Monitoring FAQ
An exclusion is an administrative action taken against an individual or entity by the Dept. of Health and Human Services (HHS), Office of Inspector General (OIG) or a State Medicaid Agency.
OIG imposes exclusions under the authority of sections 1128 and 1156 of the Social Security Act. If an individual or entity is excluded, they are prohibited from participating in reimbursements for or from federally funded healthcare programs through the Centers for Medicare and Medicaid Services (CMS). Once an individual or entity is excluded, they are considered excluded in all states.
Healthcare organization who bill federal and state healthcare programs should be checking both federal and state Medicaid exclusion lists. The two federal exclusion sources are OIG LEIE and the SAM.gov database.
There are currently 43 state Medicaid excluded/sanctioned/terminated provider lists. Each list is updated and distributed at different intervals and in various formats, making it difficult to verify and screen without a third party.
Exclusion data is messy, incomplete, and varies greatly by source. Our verification tools use sorting algorithms and advanced data grouping to make a more complete profile for providers, employees, healthcare vendors, and more which is not present on government databases or registries. ProviderTrust maintains a proprietary grid of excluded individuals and entities that enhances state and federal exclusion data with additional unique identifiers and additional information (such as license number, NPI, former names, etc.).
Exclusion data is messy, incomplete, and varies greatly by source. Our verification tools use sorting algorithms and advanced data grouping to make a more complete profile for providers, employees, healthcare vendors, and more which is not present on government databases or registries. ProviderTrust maintains a proprietary grid of excluded individuals and entities that enhances state and federal exclusion data with additional unique identifiers and additional information (such as license number, NPI, former names, etc.).
