Healthcare exclusion screening checklist
A free checklist and editable worksheet for preparing a screening run, reviewing possible matches, and retaining a usable audit record.
Content review and source verification
- Last reviewed
- Last verified
- Content owner
- Exclia content team
- Review cadence
- Every 90 days
- Next review due
Use this worksheet for your current workforce, contractors, and vendors. Select sources and timing for your programs, states, roles, and contracts; completing it does not certify compliance.
Start a screening run
Download the plain-text worksheet, open it in a text editor, and save a copy for each run. Print the worksheet from your text editor or save it as a PDF. It includes source logs, match review records, and reviewer sign-off fields. No account or email is required. Keep completed records in your approved internal system.
Download the editable worksheet (.txt)Source guidance reviewed:Set the schedule for your organization
OIG recommends monthly LEIE screening to reduce risk; it does not set a universal statutory screening frequency for all providers. Your state, payer, or contract may impose specific duties. Record those separately in the worksheet.
Read OIG’s frequency guidancePlan your monthly screening workflowExplore state requirement guides1. Prepare the roster
Assign a screening owner and a reviewer for unresolved results.
Guidance: Monthly screening workflow and evidence guidanceReconcile the roster with current workforce and vendor records; record additions, departures, and the roster version.
Guidance: Monthly screening workflow and evidence guidanceInclude relevant contracted and support roles, based on whether their work is paid directly or indirectly by federal healthcare programs.
Guidance: OIG guidance on screening scope and timingCollect legal names, known former names or aliases, and available identifiers through approved internal channels.
Guidance: OIG search and identity-verification instructions
2. Choose sources and timing
Include the OIG LEIE for OIG exclusions. Identify any additional state Medicaid, payer, or contract sources that apply and record the authority for each.
Guidance: OIG guidance on screening scope and timingRecord each source’s URL, data edition or update date, and the date searched. A failed or unavailable source is an incomplete check, not a clear result.
Guidance: OIG guidance on screening scope and timingSet the next run date and record its basis: organizational policy, agency guidance, or a specific state or contract requirement.
Guidance: OIG guidance on screening scope and timing
3. Screen new hires and vendors before engagement
Screen prospective employees, contractors, and in-scope vendor personnel before employment or contracting; record the check date and onboarding decision.
Guidance: OIG guidance on screening scope and timingWhen relying on a staffing agency or vendor to screen, obtain and retain documentation showing who was checked, when, and against which sources; validate that the agreed screening occurred.
Guidance: OIG guidance on screening scope and timingAssign potential matches to a reviewer and escalate unresolved cases before approving affected work. Add engaged people and entities to the recurring roster.
Guidance: Monthly screening workflow and evidence guidance
4. Own and monitor recurring screening
Name a run owner, backup, match reviewer, and compliance escalation owner; document responsibilities and follow-up deadlines.
Guidance: Monthly screening workflow and evidence guidanceSchedule recurring checks using the documented timing basis. OIG recommends monthly LEIE checks; verify any state, payer, or contract duties separately.
Guidance: OIG guidance on screening scope and timingReconcile screened counts with the roster and selected sources. Investigate missed runs, failed searches, and stale data; repeat affected checks and track open reviews.
Guidance: Monthly screening workflow and evidence guidance
5. Run and document searches
Search each selected source using its official instructions, including relevant name variations.
Guidance: OIG search and identity-verification instructionsSave the initial search results and any follow-up searches, including searches with no results.
Guidance: OIG search and identity-verification instructionsIf using downloaded LEIE data, use a current full file or correctly apply both exclusion and reinstatement supplements; record which version was used.
Guidance: OIG search and identity-verification instructions
6. Resolve possible matches
Treat a matching name as a possible match pending identity review; compare available identifying details.
Guidance: OIG search and identity-verification instructionsFor a possible LEIE match, use OIG’s online SSN or EIN verification. If identity remains uncertain, contact OIG for assistance and keep the case unresolved.
Guidance: OIG search and identity-verification instructionsRecord the reviewer, evidence, disposition, and review date. Escalate confirmed or unresolved cases to the designated compliance owner for decisions about affected work, payments, and reporting.
Guidance: OIG exclusion and reinstatement FAQsDo not infer reinstatement from an elapsed exclusion period; verify current status with the issuing authority.
Guidance: OIG exclusion and reinstatement FAQs
7. Close the run and retain evidence
List missing roster entries, unavailable sources, and open match reviews; assign an owner and follow-up date for every gap.
Guidance: Monthly screening workflow and evidence guidanceRetain the roster version, source versions, search evidence, and review decisions under your organization’s retention and access policies.
Guidance: Monthly screening workflow and evidence guidanceRecord reviewer sign-off and the next screening date. A run with open gaps should remain marked incomplete.
Guidance: Monthly screening workflow and evidence guidance
8. Prepare an audit evidence packet
Index the roster snapshot, source register, search results, match decisions, vendor evidence, and sign-off by run date in an approved evidence location.
Guidance: Monthly screening workflow and evidence guidanceWalk through a sample record from roster to search to disposition so a reviewer can reconstruct the check, including any verification evidence.
Guidance: Monthly screening workflow and evidence guidanceInclude incomplete runs, outstanding cases, corrective actions, owners, and due dates. Confirm access controls and the applicable retention policy; do not treat a downloaded report as compliance certification.
Guidance: Monthly screening workflow and evidence guidance
Official instructions and next steps
- OIG: Effect of Exclusion — screening scope, frequency, and documentation
- OIG: LEIE Quick Tips & Instructions — searching and identity verification
- OIG: Exclusions FAQs — possible matches and reinstatement
