Name-only searches miss excluded providers. Our five-layer match methodology — NPI, SSN, phonetic, fuzzy logic, and entity matching — closes the gaps that put your Medicare billing at risk.
The OIG LEIE contains over 83,000 excluded individuals and entities. Standard name searches return false confidence — missing providers due to spelling variants, maiden names, misspellings in source data, and entity structures that obscure individual exclusions.
Excluded providers are listed as they appear in OIG administrative records — not necessarily how they present on your roster. A single character difference passes a name-only check and clears an excluded individual.
Exclusions follow the individual — not the name on file. Providers who change names after exclusion do not trigger standard string-match screens. SSN and DOB cross-referencing is the only reliable catch.
An entity exclusion tied to a practice owner or officer does not appear under an employee's name. Without entity-level matching, individual providers can pass screening while operating under an excluded organizational umbrella.
"Billing for services rendered by an excluded provider is grounds for repayment demand — regardless of whether the organization knew."
Our proprietary screening engine applies five independent match layers against the current OIG LEIE dataset. Every individual on your roster is evaluated against all five simultaneously — not sequentially — before a result is returned.
Direct National Provider Identifier cross-reference against LEIE records. Authoritative identifier match where NPI data is available. Zero false negative rate at this layer for active enrolled providers.
Social Security Number and date of birth matching catches providers who have changed names post-exclusion. The single most effective catch layer for exclusions that predate roster onboarding.
Soundex and Metaphone algorithms detect excluded providers whose names are phonetically similar but spelled differently. Surfaces matches that exact string comparison cannot reach.
Levenshtein distance scoring identifies close-match name variants caused by transposition, truncation, abbreviated first names, and common data-entry errors in both source and LEIE records.
Organization and DBA name screening to surface entity-level exclusions that may implicate individual providers or ownership structures. Critical for group practices, staffing vendors, and multi-entity operators.
Flat-rate pricing structured for independent practices, post-acute agencies, and staffing organizations. Every tier includes the same five-layer methodology and branded compliance certificate.
Any entity participating in a federal healthcare program is required to screen against the LEIE. The obligation runs to employees, contractors, governing board members, and downstream vendors providing items or services.
Physicians, mid-levels, clinical staff, and billing vendors all carry individual screening obligations. Group practices with high turnover face particular exposure at onboarding and quarterly reviews.
IDT members, attending physicians, contracted clinical staff, and volunteers rendering Medicare-billable services must be screened. Hospice PPEO reviews increasingly include LEIE documentation requests.
Field clinicians with high geographic dispersion and contractor-heavy staffing models create significant exclusion exposure. Monthly automated screening is operationally essential for HHA compliance programs.
CMS conditions of participation and the OIG's SNF compliance program guidance both reference LEIE screening as a baseline requirement. SNFs with therapy contractor relationships carry downstream vendor screening obligations.
Agencies placing clinical staff with Medicare-participating facilities bear the initial screening obligation. Client facilities may also require vendor-level certification of exclusion screening as a contract condition.
Durable medical equipment suppliers, diagnostic vendors, and any organization submitting claims or receiving Medicare/Medicaid reimbursement must maintain LEIE compliance for all personnel with program involvement.
Every screening engagement produces a branded compliance certificate and supporting findings documentation — formatted for program audit response, accreditation review, and internal governance files.
A Prognosis Consulting–issued PDF certificate documenting screening date, methodology applied, roster size, and overall result. Formatted for placement in compliance program records.
Per-provider result for every individual screened — which layers were applied, whether a match was returned, and adjudication status for any flagged record requiring manual review.
Where a phonetic, fuzzy, or entity match is returned, a written narrative explains the match basis and recommended next steps — including when a confirmed exclusion is found.
Full citation of the OIG LEIE dataset version and pull date used for each screening. Required for audit-ready compliance files and satisfies documentation requirements under most accreditation standards.
All deliverables are transmitted via encrypted file transfer. No PHI is retained post-delivery. Roster data is processed in-memory and not written to disk or stored in any cloud environment.
Roster data submitted for LEIE screening typically does not constitute protected health information (PHI) under HIPAA — it contains demographic identifiers used for exclusion matching, not clinical records. A Business Associate Agreement is not required for the LEIE screening tool itself. BAA obligations under our Google Workspace and secure file transfer infrastructure are separately maintained. We recommend clients confirm this position with their own compliance counsel for any population where PHI and roster data may overlap.
The OIG updates the LEIE on a monthly basis. Our engine pulls the current dataset at the time of each screening engagement. For monthly subscription clients, the dataset is refreshed prior to each automated cycle on the 1st of the month. Every certificate documents the specific dataset version and pull date used — a requirement for audit-defensible compliance files.
When a match is returned — whether phonetic, fuzzy, or entity — our certificate includes a written flag narrative explaining the match basis and recommended next steps. For confirmed exclusions, we provide the OIG exclusion detail and advise on immediate remediation steps. Confirmed exclusion findings can be escalated into a broader compliance engagement if organizational response planning is required.
OIG guidance recommends — and CMS conditions of participation for most provider types reference — screening at hire and at a minimum monthly thereafter. A monthly subscription with documented certificates satisfies the timing requirement. We strongly recommend maintaining screening certificates in your compliance program files alongside your exclusion screening policy and procedure. We do not provide legal advice; this position should be confirmed with healthcare counsel for your specific provider type and payer mix.
Yes. OIG guidance extends the screening obligation beyond W-2 employees to contractors, governing board members, and downstream vendors providing items or services under the program. Roster slots can be allocated across any combination of individuals — your submission defines who is screened. We do not restrict screening populations within a purchased tier.
Roster data is processed in-memory by our proprietary engine and is not written to disk or retained in any cloud storage environment post-screening. No PHI is stored. Deliverables are transmitted via encrypted file transfer. Our no-PHI architecture was independently verified at the code level, and a dependency lockfile is maintained for our production environment. For organizations with specific security documentation requirements, we are happy to provide an architecture summary on request.
Submit a screening request and we will confirm scope, pricing tier, and secure roster submission instructions within one business day. One-time screenings are delivered within two business days of roster receipt.
Or email us directly at hello@prognosisconsulting.com