If your practice employs or contracts with a person who has been excluded by the HHS Office of Inspector General, no federal health care program payment may be made for any item or service that person furnishes — and the practice can face civil monetary penalties and repayment liability. There is no statute or regulation that requires you to check the List of Excluded Individuals and Entities (LEIE); OIG says so directly. But OIG updates the LEIE monthly and states that screening employees and contractors each month best minimizes potential overpayment and CMP liability. That is the whole calculus: the check is optional, the liability is not.
The rule in one paragraph
Per OIG's Updated Special Advisory Bulletin on the Effect of Exclusion, the payment prohibition applies to items or services furnished (1) by an excluded person, or (2) at the medical direction or on the prescription of an excluded person. It applies across every payment methodology — itemized claims, cost reports, fee schedules, capitated rates, bundled or prospective payments — and it applies even when the excluded person's services are not separately billed. If a provider arranges or contracts with someone it knows or should know is excluded, OIG may impose CMPs of up to $10,000 for each item or service furnished for which federal program payment is sought, plus an assessment of up to three times the amount claimed, and program exclusion. (Penalty amounts under the Civil Monetary Penalties Law are periodically adjusted for inflation; confirm the current figures before quoting them.)
Why monthly is the right cadence
OIG's guidance on frequency is unusually plain:
- Providers should check the LEIE prior to employing or contracting with a person, and periodically thereafter for current employees and contractors.
- Providers are not required by statute or regulation to check the LEIE. It is a tool OIG makes available.
- Because there is no requirement, providers may decide how frequently to check — but OIG updates the LEIE monthly, so screening each month best minimizes potential overpayment and CMP liability.
- OIG also notes that in 2009 CMS issued a State Medicaid Director Letter recommending that states require providers to screen all employees and contractors monthly, and that in 2011 CMS issued final regulations requiring states to screen all enrolled providers monthly.
The practical reading: monthly, against the current LEIE, for everyone in scope, with a record you can produce. Anything less frequent means you are knowingly carrying an exposure window equal to the gap.
Who you actually have to screen
OIG's recommended method is to review each job category and each contractual relationship and ask a single question: is the item or service being provided, directly or indirectly, in whole or in part, payable by a federal health care program? If yes, screen everyone performing under that contract or in that job category.
| Category | Screen? | Note |
|---|---|---|
| Employed clinicians and clinical staff | Yes | The obvious case |
| Contractors and their employees | Yes | OIG says to apply the same analysis you would to your own employees |
| Staffing-agency nurses and locums | Yes | Named explicitly in OIG's guidance |
| Billing and coding contractors | Yes | Also named explicitly |
| Contracted physician groups (e.g., ER coverage) | Yes | Also named explicitly |
| Volunteers | Yes, if in scope | An excluded person may not furnish payable services "regardless of whether the person is an employee, a contractor, or a volunteer" |
| Ordering / prescribing physicians | Yes, at the point of service | Items furnished on an excluded prescriber's order are not payable; a valid license or DEA number does not mean the prescriber is not excluded |
You may choose to rely on a contractor's own screening — a staffing agency, a billing company — but OIG recommends you validate that they are doing it, for example by requesting and retaining their screening documentation. And regardless of who screens, you retain overpayment liability and may face CMP liability if appropriate screening was not performed.
It is not just clinical staff
This is the part that surprises practice managers. OIG states that excluded persons are prohibited from furnishing administrative and management services payable by federal health care programs — even when those services are not separately billable. The bulletin's own examples of roles an excluded individual may not hold include chief executive officer, chief financial officer, general counsel, director of health information management, director of human resources, and physician practice office manager. It also names health information technology services and support, strategic planning, billing and accounting, staff training, and human resources.
So the scope of "who gets screened" is not the clinical roster. It is everyone whose work touches the delivery of services payable by a federal program — front desk, billing, IT support, management, and the office manager reading this sentence.
How to run the check properly
- Use the LEIE as the primary source. OIG recommends it over other databases for exclusion screening because OIG maintains it, updates it monthly, and includes more detail (statutory basis, occupation at exclusion, date of birth, address).
- Search the online searchable database for verification. The downloadable data file does not contain SSNs or EINs — so verifying a specific individual or entity by SSN or EIN must be done through the online searchable database.
- Search every name the person has used. The LEIE contains only the name known to OIG at the time of the exclusion. Maiden names, prior married names, and name variants all need to be run.
- Use the monthly supplement files if you maintain your own copy of the database — they list what has been added and removed each month and can be merged into a previously downloaded file.
- Screen before you hire or contract, then monthly thereafter.
Documenting it so it counts
An unrecorded screen is, for practical purposes, a screen that did not happen. OIG's guidance is specific: when checking the LEIE, providers should maintain documentation of the initial name search performed — such as a printed screenshot showing the results — and of any additional searches conducted to verify results of potential name matches.
Build the artifact so an auditor can reconstruct it without you in the room:
- A monthly log: date run, who ran it, the list of names screened, the source (LEIE), and the result for each.
- Saved screenshots or exports of the search results — including the clean ones.
- For any potential name match: the follow-up search, the SSN/EIN verification through the online database, and the written conclusion.
- For contractors who screen on your behalf: their documentation, requested and retained, plus a contract clause obligating them to do it.
- A named owner and a recurring calendar entry. Monthly cadences die when they belong to nobody.
LEIE vs. SAM vs. NPDB
| Database | What it contains | Use it for |
|---|---|---|
| LEIE (OIG) | Only exclusion actions taken by OIG; updated monthly; includes statutory basis, occupation, DOB, address; SSN/EIN verification via the online search | The primary source for exclusion screening of employees and contractors |
| SAM (GSA) | OIG exclusions plus debarment actions taken by federal agencies | Federal procurement eligibility. Note: OIG has no authority to impose CMPs based on employing a debarred person |
| NPDB | Malpractice payments, adverse licensing and privileging actions, and the data formerly in the HIPDB | Credentialing. OIG still recommends the LEIE as the primary database for exclusion screening |
What if you find a match
- Verify before you act. Name matches are common. Confirm through the online searchable database using SSN or EIN, and document the verification.
- If it is confirmed, stop the exposure. The person may not furnish any item or service — clinical, administrative, or managerial — that is payable, directly or indirectly, by a federal health care program.
- Quantify. Identify what was billed and when. Overpayment liability attaches to items and services furnished by the excluded person for which you received federal program reimbursement.
- Consider OIG's Provider Self-Disclosure Protocol. OIG explicitly directs providers who identify potential CMP liability from employing or contracting with an excluded person to use the SDP to disclose and resolve it.
- Get counsel involved before you self-disclose. This is the point at which the practice manager hands off.
The narrow exception worth knowing: a provider may employ or contract with an excluded person if federal health care programs do not pay, directly or indirectly, for the items or services that person provides — for example, work furnished solely to non-federal-program patients. In a small practice, that separation is almost always harder to maintain than it sounds, and the burden of proving it lands on you.
Common questions
Are we legally required to check the LEIE?
No. OIG states that providers are not required by statute or regulation to check the LEIE. But the payment prohibition and CMP liability apply whether or not you checked — and OIG says that because it updates the list monthly, screening each month best minimizes potential overpayment and CMP liability.
How often should we screen?
Monthly, matching OIG's update cadence. Screen before hiring or contracting, and then on a recurring monthly basis for current employees and contractors.
Do we have to screen non-clinical staff?
Yes, where their work relates to items or services payable by federal health care programs. OIG's guidance names roles such as physician practice office manager, HR, IT support, and billing and accounting as positions an excluded individual may not hold.
Can we rely on our staffing agency's screening?
You may choose to, but OIG recommends validating that the contractor is actually doing it — for instance, by requesting and retaining their screening documentation. Regardless of who performs the screen, the provider retains overpayment liability and may face CMP liability if appropriate screening was not performed.
Common questions
Are we legally required to check the OIG LEIE?
No. OIG states that providers are not required by statute or regulation to check the LEIE. But the payment prohibition and civil monetary penalty liability apply whether or not you checked, and OIG says that because it updates the list monthly, screening employees and contractors each month best minimizes potential overpayment and CMP liability.
How often should a practice screen for exclusions?
Monthly, matching OIG's update cadence. Screen before employing or contracting with a person, then screen current employees and contractors on a recurring monthly basis.
Do we have to screen non-clinical staff?
Yes, where their work relates to items or services payable by federal health care programs. OIG's guidance states excluded persons may not furnish administrative and management services, and names roles including physician practice office manager, human resources, IT support, and billing and accounting.
Can we rely on our staffing agency's screening?
You may, but OIG recommends validating that the contractor is actually conducting the screening, for example by requesting and maintaining their screening documentation. Regardless of who screens, the provider retains overpayment liability and may face CMP liability if appropriate screening was not performed.