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Browse through our comprehensive resources designed by exclusion experts to offer you support and guidance.
Providers' Guides
A Provider Guide to New York Medicaid Exclusion Screening
June 19, 2024
This article focuses on helping providers understand New York Medicaid exclusion screening law, and its...
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Medicaid Exclusion Summaries
A Provider Guide to Alabama Medicaid Exclusion Screening
April 26, 2024
Alabama’s Medicaid Program will not pay for any item or service furnished by, or at the medical direction...
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Medicaid Enforcement
Current States With a Separate Medicaid Exclusion List
April 22, 2024
Map of the States with a Separate Medicaid Exclusion List Click on your state to view their Medicaid...
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Preclusion List Screening
Comparison between OIG Exclusion List and CMS Preclusion List
April 22, 2024
OIG Exclusion List vs. CMS Preclusion List Since the CMS Preclusion list was announced in April 2018,...
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Exclusion Basics
What is an Exclusion Waiver and Who May Apply for one?
April 16, 2024
We have previously discussed that once a provider is excluded he may not furnish items or services...
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Medicaid Enforcement
California Exclusion List Screening Requirements
March 21, 2024
What are the California Exclusion List Screening requirements? The Medi-Cal Program will not pay...
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Medicaid Enforcement
Providers' Guides
Pennsylvania Medicheck Preclusion List: A Provider’s Guide to Screening
February 28, 2024
The Pennsylvania Precluded Provider List, commonly referred to as “Pennsylvania Medicheck,” identifies...
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Exclusion Basics
How the LEIE, GSA/SAM, and State Exclusion Lists Differ; And Why They Need to be Screened
February 19, 2024
Exclusions and debarments are powerful administrative sanctions imposed by Federal and State agencies....
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Effect of an Exclusion
Providers' Guides
A Provider’s Guide to the GSA SAM Database.
January 16, 2024
The importance of screening employees, vendors and contractors against available federal and State exclusion...
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Exclusion Basics
Why is it Necessary to Screen Against the NPPES and its NPI Registry Database?
December 15, 2023
We are sometimes asked, “Why do you screen against the National Plan and Provider Enumeration System...
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Medicaid Enforcement
An Overview of the Medi-Cal Suspended and Ineligible Provider List
November 17, 2023
Most healthcare providers and suppliers in the State of California are aware that exclusions imposed...
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Providers' Guides
A Provider's Guide to OIG Exclusions
November 14, 2023
A Provider’s Guide to OIG Exclusions: Federal Exclusion Regulations and Enforcement Authorities, and...
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Exclusion Basics
What is an OIG Exclusion?
November 10, 2023
OIG Exclusions are powerful enforcement sanctions that bar an individual or entity from any participation...
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Medicaid Enforcement
Why Should We Screen Against the Social Security Administration Death Master File?
October 1, 2023
At Exclusion Screening, we often receive questions about the scope and frequency of an organization’s...
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Effect of an Exclusion
Resolving Exclusion Violations through the OIG Self-Disclosure Protocol
August 31, 2023
I. Introduction The Office of Inspector General (OIG) has the authority to exclude providers from participating...
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Effect of an Exclusion
Medicare / Medicaid Providers Beware: A Nolo Contendere Plea to a Non-Health Care Crime Can Still Result in Exclusion from Medicare
March 2, 2022
The last two years have been rough for everyone, and it has been particularly difficult for healthcare...
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Effect of an Exclusion
The Proposed Expansion of CMS’ Revocation Authority Makes Monthly Exclusion Screening of ALL Employees More Important than Ever!
November 2, 2021
The Centers for Medicare and Medicaid Services (CMS)[1] is the Federal agency tasked with the overall...
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Effect of an Exclusion
When an Underlying Misdemeanor or Felony Conviction is Expunged, Does That Extinguish an Exclusion Action?
October 25, 2021
Medicare and Medicaid providers / suppliers are prohibited from employing individuals who have been excluded...
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Medicaid Enforcement
North Carolina Exclusion Screening Requirements
August 23, 2021
To understand the North Carolina Exclusion Screening Requirements, we must first touch upon Exclusions...
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Exclusion Basics
What is the NPDB?
April 28, 2021
I. What is the NPDB The National Practitioner Data Bank (NPDB) was created as part of the Health Care...
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Exclusion Basics
What is the Length of A Mandatory Exclusion?
January 8, 2021
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) is responsible for...
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Exclusion Basics
What is the Scope of a Mandatory Exclusion Brought Under Section 1128(a)(4) of the Social Security Act (Act)?
December 22, 2020
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) exercises both mandatory...
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Medicaid Enforcement
Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B) -- The Collateral Consequences of a State Medicaid Enrollment Termination Action
November 23, 2020
Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B) (November 2020): Since 1976, the Department...
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Effect of an Exclusion
A State Conviction for “Patient Neglect” Will Result in Mandatory Exclusion from Participation in Federal Health Benefit Programs
April 1, 2020
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) may be required...
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Effect of an Exclusion
I Have a Confirmed Exclusion What are my Options
March 30, 2020
After finding a confirmed exclusion among your employees, vendors, contractors, or volunteers there are...
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Medicaid Enforcement
Massachusetts Medicaid Exclusion Screening Requirements
January 16, 2020
Massachusetts Medicaid Exclusion Screening: Requirements and Best Practices for Compliance The Massachusetts...
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Effect of an Exclusion
Can a Medicare Provider or Supplier Hire an Excluded Individual or Enter in a Contract with an Excluded Entity on the Medicare Exclusion List?
October 9, 2019
Should you choose to participate in the Medicare and/or Medicaid programs, you must comply with a wide...
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Medicaid Enforcement
Pennsylvania Doctor Excluded in Connection with Quality of Care
September 26, 2019
Over the past year, both State and Federal law enforcement investigators and prosecutors have gone to...
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Medicare Enforcement
OIG Semiannual Report to Congress: Fall 2018-Spring 2019
June 10, 2019
The Office of Inspector General (OIG) recently published its Semi-Annual Report to Congress covering...
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Medicaid Enforcement
Alabama Exclusion Screening Requirements
May 3, 2019
(May 2, 2019) The Alabama Medicaid Program imposes significant exclusion screening requirements on its...
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Compliance Hotlines
New Evidence Shows the Efficiency and Benefits of Using an Internal Compliance Hotline System
April 8, 2019
(April 4, 2019): In December of 2018 a study was conducted by Kyle Wench (George Washington University)...
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Medicare Enforcement
OIG Enforcement Actions: Notable Decisions from March 2019
April 2, 2019
(April 2, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG),...
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Medicare Enforcement
February Recap of OIG Enforcement Actions: Notable Decisions
March 1, 2019
(March 1, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG),...
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Preclusion List Screening
What to Know About the New CMS Preclusion List
February 13, 2019
Beginning April 1, 2019, the new CMS Preclusion List will go into effect subsequently barring many healthcare...
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Medicare Enforcement
A Review of OIG Enforcement Actions in Fiscal Year 2018
February 7, 2019
By Cason Liles (February 6, 2019): The Department of Health and Human Services (HHS), Office of...
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Medicare Enforcement
OIG Enforcement Actions: Notable Decisions from January 2019
February 6, 2019
(February 6, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG),...
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Providers' Guides
A Provider’s Guide to Texas Medicaid Exclusions: Exclusion Screening Requirements and Best Practices for Compliance
December 17, 2018
(December 17, 2018): Texas Medicaid Exclusions will prevent the Texas Medicaid Program from...
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Medicare Enforcement
OIG Exclusion Case Study: The Impact of a False Claims Act Judgment.
August 30, 2018
(August 23, 2018): In 2008, after learning that a Texas-based laboratory services company was submitting...
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Effect of an Exclusion
Health Care Providers Should Consider the Ramifications of “Taking a Plea” in a Criminal Case or Agreeing to a Licensure Action. It May Trigger a Mandatory or Permissive OIG Exclusion Action.
July 30, 2018
Perhaps the most severe administrative sanction available under the Social Security Act stems from the...
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Medicaid Enforcement
Personal Care Service Aides and Attendants Excluded in 2017
January 22, 2018
(January 22, 2018): With 2017 behind us, it can be quite helpful to review the Medicare “exclusion”...
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Medicare Enforcement
Dental OIG Exclusions - A Review of 2017 Actions.
January 12, 2018
(January 12, 2018): The Medicare and Medicaid programs are both essential, yet costly health benefit...
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Effect of an Exclusion
Reciprocal Licensure Actions Can Lead to Medicare Revocation and Exclusion
January 8, 2018
(January 8, 2018): Most physicians will progress through their entire career without ever having...
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Medicare Enforcement
The Released Year in Review OIG Podcast
December 22, 2017
Year in Review OIG Podcast Earlier this week, the Office of Inspector General released its “Year in...
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Medicare Enforcement
Pain Management Prescribing Practices and Audits
August 16, 2017
(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive...
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Medicare Enforcement
Significant Recent Trends in Exclusion Case Settlements
June 8, 2017
The Office of the Inspector General (OIG) has recently entered into a number of exclusion case settlements tied...
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Medicare Enforcement
Health Care Fraud to Remain a DOJ Priority
May 26, 2017
Exclusion News (May 22, 2017): By Paul Weidenfeld Health Care Fraud will continue to be a high priority...
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Effect of an Exclusion
The New “Seventh Element” of Compliance: Screening and Evaluating Employee Suitability!
May 3, 2017
The recently issued Resource Guide for Measuring Compliance Program Effectiveness, reconfigures the traditional...
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Effect of an Exclusion
Home Health Final Rule Extends Exclusion Screening Obligation: Failure to Screen Could Result in Termination from Medicare
March 29, 2017
By Paul Weidenfeld The new Final Rule issued by CMS revising the conditions of participation for home...
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Medicare Enforcement
Pharmacies Targeted for Exclusion Violations by OIG and States
February 13, 2017
In what appears to be a growing enforcement trend, the Department of Health and Human Services, Office...
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Medicare Enforcement
Excluded Dentist Pays Record $1.1 Million and Agrees to 50 Year Exclusion
January 31, 2017
Exclusion Violation by Dentist “Sends a Strong Warning” February 1, 2017 By Paul...
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Medicaid Enforcement
OIG Issues Final Rule Expanding Exclusion Authority
January 24, 2017
By Paul Weidenfeld January 23, 2017 On January 12, 2017, the Office of Inspector General published a...
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Medicare Enforcement
DOJ Announces $4.7B in FCA Recoveries: What Does It Mean?
December 16, 2016
DOJ Announces $4.7 billion in FCA Recoveries By Paul Weidenfeld December 16, 2016 The “Third Best...
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Medicare Enforcement
OIG Imposes Record Penalties for Exclusion Violations
September 7, 2016
OIG Imposes Record $21.5 Million in Penalties for Exclusion Violations! The OIG imposed a record $21.5...
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Exclusion Basics
What Medical Practices Need to Know About OIG Exclusion Screening
August 9, 2016
[1] The Office of Inspector General (OIG) has steadily increased its enforcement of OIG Exclusion Screening...
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Medicare Enforcement
DOJ Doubles Down on False Claims Act Penalties!
August 2, 2016
By Robert W. Liles. August 3, 2016. The False Claims Act is the primary...
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Medicaid Enforcement
OIG Issues Updated Criteria for Implementing Its Permissive Exclusion Authority
May 4, 2016
On April 18, 2016, the Department of Health and Human Services, Office of Inspector General (HHS-OIG)...
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Exclusion Basics
How to Apply for OIG Reinstatement
March 4, 2016
I. The OIG Reinstatement Process Most exclusions are imposed for a definite time period....
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Compliance Hotlines
How Compliance Hotlines Can Save You Money!
March 4, 2016
By Paul Weidenfeld, March 4, 2016. An essential element of all compliance plans is developing and...
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Medicare Enforcement
2016 OIG Work Plan: State Medicaid Agencies Must Comply with Exclusion Rules
December 4, 2015
The Office of Inspector General’s 2016 OIG Work Plan contains two important projects that focus...
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Medicaid Enforcement
Exclusion Loophole: Medicaid Managed Care
October 12, 2015
In August, we discussed an OIG audit, which revealed that Medicaid providers who were terminated for...
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Effect of an Exclusion
Who Is to Blame for Gaps in OIG and State Exclusion Lists? What Is the Impact on Providers?
September 23, 2015
The failure to report excludable offenses by state Medicaid offices and licensing boards is a longstanding...
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Medicare Enforcement
Health Care Fraud: Second Conviction Secured in Michigan Excluded Provider Scheme
September 8, 2015
In February, we reported that the Michigan Attorney General secured a racketeering and health care fraud...
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Medicare Enforcement
Pennsylvania Judge Holds that CIA violations May Result in FCA Liability
September 1, 2015
In late July, a federal district court in Pennsylvania joined in the flurry of False Claims Act (FCA)...
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Medicare Enforcement
2015 Mid-Year Exclusion Enforcement Action Review
August 27, 2015
OIG has been busy cracking down on providers who employ or contract with excluded persons or contractors. ...
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Medicare Enforcement
Excluded Individual Conducts Elaborate Health Care Fraud Scheme
August 26, 2015
The owner of a New Jersey ambulance company was indicted for health care fraud in mid-August of...
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Exclusion Basics
Exclusion Screening Required in United States Territories
August 21, 2015
Our experts at Exclusion Screening, LLC maintain fact sheets that contain the screening requirements...
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Compliance Hotlines
Why Do I Need a Compliance Hotline?
August 20, 2015
https://www.exclusionscreening.com/wp-content/uploads/2018/06/Why-do-you-need-a-compliance-Hotline.mp4 One...
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Effect of an Exclusion
Southern District of New York Provides Clarity on “Identifying” Overpayments
August 14, 2015
In early August of 2015, the Southern District of New York (SDNY) provided insight as to when the...
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Effect of an Exclusion
Recent Developments on the 60-day Rule and the Potential Impact on Exclusion Violations
August 11, 2015
The Affordable Care Act (ACA) creates a 60‑day window to report and return overpayments from Medicare...
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Medicaid Enforcement
Medicaid Providers That Are Excluded or Terminated for Cause Often Continue to Participate in Other States According to a New OIG Audit
August 10, 2015
OIG Audit Findings In a recently released audit, the OIG found that despite the ACA requirement...
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Medicare Enforcement
DOJ Files Another False Claims Act Case Based on OIG Exclusion Violations
July 29, 2015
DOJ Pursuing Action on Two Separate OIG Exclusion Violations The U.S. Attorney’s Office in Philadelphia...
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Medicare Enforcement
Exclusion Alert: Assistant Inspector General Tells Congress That Exclusion Violations Plague Part D
July 23, 2015
Assistant Inspector General Testifies before Congress Ann Maxwell, the Assistant Inspector General for...
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Medicare Enforcement
OIG Announces Creation of Special Unit for CMP and Exclusion Litigation
July 1, 2015
Exclusion Screening, LLC has been chronicling the Office of Inspector General’s (OIG) interest...
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Exclusion Basics
Exclusion Screening of Contractors and Vendors
June 30, 2015
This article was written by Paul Weidenfeld [1] By now, providers should be aware that the Office of...
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Exclusion Basics
Exclusion Screening Basics for Providers
June 22, 2015
Exclusion Screening Is Mandatory Providers of medical services that participate in Federal or State Health...
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Medicare Enforcement
DOJ Announces New FCA Settlements involving Excluded Persons including a $6.5 Million Settlement involving Services Provided by a Private Duty Nurse Investigated by OIG
June 16, 2015
The Department of Justice (DOJ) recently announced two new False Claims Act (FCA) settlements involving...
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Medicare Enforcement
Exclusion Case Review: 1st Quarter of 2015 Evidences an Increase in Enforcement Efforts by OIG
June 16, 2015
(This article was originally posted in the National Alliance of Medical Auditing Specialists‘ “Tip...
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Medicare Enforcement
HHS/OIG Excludes Illinois Home Health Agency for Exclusion Violation!
May 17, 2015
Home Health Agency Excluded for Employing Excluded Nurse HHS/OIG recently issued a press release announcing...
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Medicaid Enforcement
OIG Releases Medicaid Fraud Control Unit (MFCU) Annual Report for FY2014
April 29, 2015
I. Gains in State Exclusion Enforcement Efforts Highlighted The Office of the Inspector General’s...
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Medicaid Enforcement
Medicare and Medicaid Exclusion Screening Compliance: A Challenging Problem with a Surprisingly Simple Solution©
April 26, 2015
Since August 2014, the Office of Inspector General (OIG) has collected roughly $3.75 Million in...
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Exclusion Basics
OIG's Updated Special Advisory Bulletin on the Effect of Exclusions
April 20, 2015
The Office of the Inspector General (OIG) Broadly Interprets Exclusion Regulations OIG’s Demonstrated...
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Medicare Enforcement
Hospital Enters into False Claims Settlement for Employee with Lapsed License
April 17, 2015
I. Hospital Employed Therapist with Lapsed License The Department of Justice (DOJ) entered...
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Medicare Enforcement
DC Contractor for Dental Providers Indicted for False Claim
April 14, 2015
I. Fraud Found in HHS’ Backyard A Virginia contractor for dental providers was recently indicted...
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Medicare Enforcement
Review of February, 2014 Exclusion Cases: Focus on Nursing Homes Remains High and the Cost of Violations Rise
March 18, 2015
I. OIG Targets Nursing Homes Last year almost half of the exclusion violation matters reported by the...
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Medicare Enforcement
Excluded Podiatrist Convicted of Racketeering and Health Care Fraud
February 19, 2015
I. Excluded Podiatrist Commits Health Care Fraud A Michigan podiatrist who was...
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Effect of an Exclusion
OIG Issues Advisory Opinion on Exclusions
February 13, 2015
I. Advisory Opinion on Payments for Services Provided Prior to Exclusion The Department of Health...
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Medicare Enforcement
2014 In Review – OIG Crack Down on Exclusion Violations
January 29, 2015
I. CMPs doubled in OIG Exclusion Violations 2014 Exclusion Screening, LLCSM dedicates a significant...
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Medicare Enforcement
OIG Trumpets Exclusions, New Actions and Recoveries in its Semi-Annual Report to Congress
January 28, 2015
I. OIG Report In the Office of the Inspector General’s (OIG) semiannual report to Congress,...
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Effect of an Exclusion
Student Loan Default Becoming a Top Reason for Exclusion
January 21, 2015
Providers are often surprised to learn that a person can be excluded from participation in federal health...
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Exclusion Basics
Medicare Enforcement
Why Should I Screen Against Every State Exclusion List?
January 19, 2015
The Office of the Inspector General (OIG) issued a Special Advisory Bulletin in May 2013, which states...
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Exclusion Basics
Who Should Be on my OIG Exclusion Screening List?
January 2, 2015
I. Federal and State Agencies Conducting Audits As many healthcare providers and suppliers have painfully...
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Medicare Enforcement
Home Health and Nursing Home Facilities a Major Target for OIG Enforcement
December 17, 2014
I. Civil Monetary Penalties Twenty-five out of the fifty-five exclusion enforcement actions reported...
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Exclusion Basics
Must Haves for a Proper Exclusion Screening Process
December 2, 2014
At Exclusion Screening, LLCSM, we know the ins-and-outs of the exclusion screening process. In our opinion,...
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Exclusion Basics
Medicare Enforcement
The Administrative Process of Imposing an OIG Exclusion
November 24, 2014
I. Mandatory OIG Exclusions When the Office of Inspector General (OIG) considers imposing a mandatory...
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Exclusion Basics
Do I Really Need to Screen My Employees and Vendors Each Month?
November 20, 2014
I. OIG Recommends Monthly Screening While there is not a formal regulation that mandates monthly...
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Medicare Enforcement
CMP Liabilities: Why Are Some Much Higher Than Others?
November 20, 2014
[visualizer id=”1978″] A quick review of the Office of Inspector General’s (OIG) exclusion...
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Medicaid Enforcement
Alert to Florida Providers Regarding Screening
November 17, 2014
I. Florida’s State Exclusion. Excluded Providers Costs OIG Over 2.7 Million The Office of...
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Medicare Enforcement
Gary Cantrell Testimony: Failures to Report Adverse Licensing Actions Leads to Gaps in the OIG-LEIE
November 12, 2014
HHS/OIG Deputy Inspector General Gary Cantrell testified earlier this year that States are failing to...
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Medicaid Enforcement
CMS Finds Fault with Exclusion Information Sharing Between States
November 12, 2014
I. Take It from CMS: If You’re Excluded in One State, You’re Excluded in All States Section...
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Medicare Enforcement
Exclusion Databases: How Difficult Is Screening and Verifying?
November 11, 2014
I. Which Exclusion Databases Do I Need to Screen? The Office of Inspector General (OIG) recommends...
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