OIG LEIE (Federal Exclusion List) vs CMS PECOS: Side-by-Side Comparison
OIG LEIE and CMS PECOS are both federal CMS/HHS systems relevant to Medicare provider eligibility, but they answer opposite questions. PECOS answers: is this provider enrolled and authorized to bill Medicare? LEIE answers: is this provider excluded and barred from billing Medicare or Medicaid? A complete provider eligibility check requires both.
OIG LEIE (Federal Exclusion List) vs CMS PECOS, across 8 dimensions
| Dimension | OIG LEIE (Federal Exclusion List) | CMS PECOS |
|---|---|---|
| Data type | Federal exclusion records — OIG-sanctioned providers barred from Medicare/Medicaid billing | Medicare fee-for-service enrollment — active billing authorization by specialty and state |
| Coverage | 68,055+ excluded individuals and entities (monthly snapshot) | ~900,000 active Medicare FFS enrollment records |
| Refresh cadence | Monthly OIG publish; Fonteum re-ingests every month | Monthly CMS publish; Fonteum ingests the monthly file |
| License / Cost | U.S. government public-domain works — free to redistribute with attribution | U.S. government public-domain works — free to use and redistribute with attribution |
| API access | Monthly CSV at oig.hhs.gov; no REST API from OIG directly | CSV bulk download via data.cms.gov; no dedicated REST API |
| Source provenance | Every exclusion record cites OIG HHS as source with snapshot date; SHA-256 snapshot digest | Source row → snapshot → SHA-256 digest chain; per-field date on every rendered value |
| Primary use case | Sanction screening — identifying excluded providers before hiring, contracting, or billing | Medicare enrollment confirmation — confirming a provider is actively enrolled and authorized to bill FFS |
| Pricing | Free (federal public domain) | Free (federal public domain) |
Cells marked "—" indicate values not publicly documented by the respective platform. No data has been estimated or fabricated.
Which platform fits your team
When to use OIG LEIE (Federal Exclusion List)
Use OIG LEIE for sanction screening — checking whether a provider is excluded from Medicare or Medicaid participation. CMS guidance requires employers and contractors to check LEIE before onboarding staff and monthly for employed personnel.
When to use CMS PECOS
Use CMS PECOS for Medicare enrollment confirmation — confirming whether a provider is actively enrolled and authorized to receive Medicare reimbursement for a given specialty and state.
Common questions
- Should I check OIG LEIE and PECOS for the same provider?
- Yes. They answer different questions. PECOS confirms enrollment (is the provider in the Medicare system?). LEIE confirms exclusion (has the provider been barred?). A provider could theoretically be enrolled in PECOS and later added to LEIE — both checks are required for a complete compliance screen.
- Can a provider be in PECOS and on the OIG LEIE simultaneously?
- In practice, CMS and OIG coordinate to terminate Medicare participation when a provider is excluded. However, there can be a lag between exclusion and enrollment termination. This is precisely why compliance programs are required to screen LEIE monthly — to catch exclusions before they create a false-billing liability.
- What is the difference between exclusion and debarment?
- OIG LEIE covers exclusion from federal healthcare programs (Medicare, Medicaid, CHIP, TRICARE). SAM.gov covers debarment from federal contracting. These are different sanctions from different agencies. A full compliance screen for a healthcare contractor typically covers both.
- How does Fonteum combine OIG LEIE and PECOS?
- Fonteum ingests both monthly (LEIE) and monthly (PECOS) and cross-resolves on NPI. A provider profile shows Medicare enrollment status from PECOS and exclusion status from OIG LEIE side by side, each with source attribution, last-checked date, and applicable limitation. The cross-resolution uses the NPI as the joining key.
Last updated 2026-05-31. See all comparisons at /compare →
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