Welcome to ExclusionCheck

ExclusionCheck combines all federal and state exclusion databases into one self-service interface, giving users access to all possible exclusion matches through individual searches or batch file uploads.

By aggregating all available sources, ExclusionCheck ensures a thorough, time-saving approach to exclusion monitoring. Developed because there was no easy way to quickly check for excluded providers, ExclusionCheck has become the most comprehensive, advanced source for exclusion searches.

Prior to ExclusionCheck, individuals would need to host monthly searches of each federal lit and all available state lists for manual review. With the introduction of PPACA 6501 and CMS, new rules and regulations require monthly license monitoring along with guidance for monthly exclusion checks, this manual process is a huge burden on your HR and compliance departments. (Read History of the OIG Exclusion List)

Now, with ExclusionCheck.com, you can come to one site to quickly determine if your employee or vendor is excluded. If there are possible matches, we provide you with a link to the primary source of data (in the result detail), so that you can verify if the exclusion is a match at the source.

With Exclusioncheck.com, your first searches are free. If you exceed your free searches, you will be directed to our friendly customer service staff who will work with you to make sure your needs are met with a comprehensive exclusion monitoring plan.


About the Data

The Excluded Provider Program

The Office of Inspector General, a federal branch of the Department of Health and Human Services is responsible for audits, evaluations, investigations, compliance initiatives and law enforcement of fraud and abuse in Medicare and Medicaid -- along with hundreds of other public health and human services programs.

In order to make sure that the health care industry stays abreast of individuals and entities that are excluded from participating in Medicare, Medicaid and all other Federal health care programs, the OIG created a program by which excluded entities and individuals are documented in order to be matched against incoming/current employee rosters. To enforce the program, the OIG has the authority to impose severe financial penalties for hiring an excluded individual.


How Does an Individual/Entity Get Excluded?

Exclusions are imposed for a variety of reasons.

Mandatory causes for exclusions include (but are not limited to):

  • Medicare or Medicaid fraud
  • Patient abuse or neglect
  • Felony convictions
  • Theft
  • Financial misconduct

Permissive exclusions include (but are not limited to):

  • Unlawful manufacture, distribution, prescription, or dispensing of controlled substances
  • Suspension
  • Revocation
  • License revocations/suspensions/surrender
  • Engaging in unlawful kickback arrangements

How Does This Effect My Organization?

Under the Affordable Health Care Act, 350 million dollars have been allocated to the Office of Inspector General for enforcement of the Excluded Provider Program. 110 million of which is to be spent in the first two years. To learn more exclusion data statistics, download CHIRP (Compliance Healthcare Index Report).

Costs of non-compliance:

  • 10K for each item/service billed
  • Fines equaling triple (3x) that of the amount paid for the services
  • possible exclusion from federal healthcare programs

*Since 2008, OIG fines average more than 100K/excluded employee. For a more in depth coverage of exclusion monitoring, read The ABC’s of Exclusion Monitoring.


Case Studies

Long-Term Care Exclusion Story - Hear from one of the largest long-term care systems in the United States as they discuss their journey to effective exclusion monitoring.

Summit Healthcare's Exclusion Monitoring Success Story - Summit Healthcare began their exclusion monitoring process and discovered their head doctor provided the social security number of a deceased person! A major risk that could have cost them a hefty fine.