Healthcare exclusion screening checklist
Source guidance reviewed: 2026-10-02
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.

RUN RECORD
Organization / team: ____________________
Run date / owner / reviewer: ____________________
Roster version / number of people and entities: ____________________
Programs / states / contracts in scope: ____________________

PREPARE THE ROSTER
[ ] Assign a screening owner and a reviewer for unresolved results.
[ ] Reconcile the roster with current workforce and vendor records; record additions, departures, and the roster version.
[ ] Include relevant contracted and support roles, based on whether their work is paid directly or indirectly by federal healthcare programs.
[ ] Collect legal names, known former names or aliases, and available identifiers through approved internal channels.
Notes / evidence location: ____________________

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.
[ ] Record 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.
[ ] Set the next run date and record its basis: organizational policy, agency guidance, or a specific state or contract requirement.
Notes / evidence location: ____________________

RUN AND DOCUMENT SEARCHES
[ ] Search each selected source using its official instructions, including relevant name variations.
[ ] Save the initial search results and any follow-up searches, including searches with no results.
[ ] If using downloaded LEIE data, use a current full file or correctly apply both exclusion and reinstatement supplements; record which version was used.
Notes / evidence location: ____________________

RESOLVE POSSIBLE MATCHES
[ ] Treat a matching name as a possible match pending identity review; compare available identifying details.
[ ] For 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.
[ ] Record 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.
[ ] Do not infer reinstatement from an elapsed exclusion period; verify current status with the issuing authority.
Notes / evidence location: ____________________

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.
[ ] Retain the roster version, source versions, search evidence, and review decisions under your organization’s retention and access policies.
[ ] Record reviewer sign-off and the next screening date. A run with open gaps should remain marked incomplete.
Notes / evidence location: ____________________

SOURCE LOG (repeat for each source)
Source / official URL: ____________________
Why applicable / timing authority: ____________________
Data version / update date / searched at: ____________________
Result / evidence location / availability gaps: ____________________

MATCH REVIEW (repeat for each possible match)
Internal subject reference / source record reference: ____________________
Verification method / evidence location: ____________________
Disposition: unresolved / different identity / confirmed match
Reviewer / review date / escalation owner: ____________________
Follow-up action / due date: ____________________
Store sensitive identifiers only in approved systems; do not write SSNs or EINs here.

RUN SIGN-OFF
Status: incomplete / complete
Open gaps / owners / due dates: ____________________
Reviewer / sign-off date: ____________________
Next run date / timing basis: ____________________
Retention policy / evidence location: ____________________

OFFICIAL SOURCES
OIG: Effect of Exclusion — screening scope, frequency, and documentation
https://oig.hhs.gov/exclusions/special-advisory-bulletin-and-other-guidance/the-effect-of-exclusion-from-participation-in-federal-health-care-programs/
OIG: LEIE Quick Tips & Instructions — searching and identity verification
https://oig.hhs.gov/exclusions/leie-quick-tips-instructions/
OIG: Exclusions FAQs — possible matches and reinstatement
https://oig.hhs.gov/faqs/exclusions-faq/

Resource: https://exclia.com/resources/exclusion-screening-checklist