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 screening monthly, because the LEIE is updated monthly and civil monetary penalty exposure accrues for every item or service an excluded party provides.

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?

An organization that employs or contracts with an excluded party risks civil monetary penalties of up to $10,000 per item or service plus treble damages, and repayment of any federal funds the excluded party touched.

Fonteum Data GlossaryRegulatory

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.

Last updated: 2026-06-20Reviewed by: Dr. Jennifer Montecillo, MD — Gullas College of Medicine, 2019. Non-practicing medical reviewer.

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 screening monthly, because the LEIE is updated monthly and civil monetary penalty exposure accrues for every item or service an excluded party provides.
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?: An organization that employs or contracts with an excluded party risks civil monetary penalties of up to $10,000 per item or service plus treble damages, and repayment of any federal funds the excluded party touched.

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