Exclusion Screening: Definition and Healthcare Context
Full name: Federal and State Exclusion Screening
Exclusion screening is the practice of checking the health care providers, vendors, and contractors an organization bills federal programs for against federal and state exclusion lists before submitting claims and on an ongoing basis. The OIG List of Excluded Individuals/Entities (LEIE) is the primary federal source; the GSA SAM.gov exclusions file and individual state Medicaid exclusion lists extend coverage. Excluded parties may not be paid, directly or indirectly, by Medicare, Medicaid, or any other federal health care program, so most compliance programs screen monthly to match CMS guidance. It is a billing and program-integrity control, not a consumer report, and must not be used for employment, credit, insurance, housing, or professional-licensing eligibility decisions about an individual.
- Source file
- Not reported
- Published
- Not reported
- Retrieved
- Not reported
- Snapshot
- Not retained for this reference page
- Re-check
- OIG: Exclusions program overview
- Data as of
- Not reported
How it’s used
- OIG LEIE (oig-leie): the monthly exclusion file is the federal baseline match against an organization's roster of providers and contractors.
- SAM.gov Exclusions: the GSA federal exclusion registry adds entity-level and procurement debarments beyond the LEIE's health-program scope.
- State Medicaid exclusion lists (state-exclusions): Pennsylvania Medicheck, North Carolina, and other state lists capture parties absent from the federal file — the federal–state coverage gap.
- Fonteum resolves each list to a provider identity so a single roster scan returns an excluded-anywhere and compromised-anywhere result with field-level provenance.
Frequently asked questions
- What is exclusion screening?
- Exclusion screening checks the providers, vendors, and contractors an organization bills federal programs for against federal and state lists of parties barred from those programs, so the organization does not bill for or pay an excluded individual.
- How often should you screen for exclusions?
- OIG guidance recommends monthly screening and OIG publishes the LEIE monthly. Fonteum's loaded release was dated May 8, 2026 when checked July 12, so consequential status must be confirmed at OIG.
- Which lists should exclusion screening check?
- Effective screening checks the federal OIG LEIE, the GSA SAM.gov exclusions file, and the relevant state Medicaid exclusion lists, since many excluded parties appear on a state list but not the federal one.
- What happens if you employ an excluded individual?
- Civil monetary penalties, assessments, and repayment can apply when federal programs are billed for items or services furnished by an excluded party. Applicable program and contract rules determine any separate employment or contracting requirements.
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