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OIG Exclusion Screening for Healthcare Staffing Agencies

The HHS Office of Inspector General (OIG) can bar people and companies from federal health care programs. Facilities that bill Medicare or Medicaid can face penalties if an excluded person works on their patients, including a nurse sent by an agency. This guide explains what exclusion means, which lists to check, what OIG and CMS actually say about how often, and what to keep on file.

Updated October 3, 2026 · Checked against the official sources listed at the end

What exclusion means

OIG keeps the List of Excluded Individuals/Entities (LEIE). OIG says that no federal health care program payment may be made for any items or services furnished, ordered, or prescribed by an excluded person. Federal health care programs include Medicare, Medicaid, and other plans funded by the United States, except the Federal Employees Health Benefits Program.

OIG's FAQ says the payment ban applies to anyone who employs or contracts with the excluded person, and to any hospital or provider where that person works. It also covers administrative and management services, not just hands-on care.

An exclusion stays in effect until OIG reinstates the person. Reinstatement is not automatic when the exclusion period ends. The person must apply, and OIG must grant it in writing. Reinstated people are removed from the LEIE.

Mandatory exclusions include convictions for program-related crimes, patient abuse or neglect, and felony health care fraud or controlled substance crimes. OIG lists a minimum of 5 years for these.
Permissive exclusions include license revocation, suspension, or surrender. OIG may exclude the person at least for the period the state licensing board imposed.

Why this matters to staffing agencies

OIG's May 2013 Updated Special Advisory Bulletin on the Effect of Exclusion is OIG's main guidance on screening. It replaced the 1999 bulletin. It uses a staffing example. If a hospital contracts with a staffing agency for temporary or per diem nurses, and an excluded nurse from that agency treats federal program patients, the hospital faces overpayment liability and may face civil money penalties.

OIG recommends that providers screen nurses provided by staffing agencies. OIG says a provider may instead rely on screening done by the agency. But OIG recommends that the provider validate it, for example by asking for and keeping the agency's screening documentation. That is why facilities ask agencies for proof of exclusion checks.

OIG also says providers that hire a third party to screen keep the potential penalty liability. Screening is a shared task. The legal risk stays with whoever is billing.

Civil money penalties

The statute is section 1128A(a)(6) of the Social Security Act, 42 U.S.C. 1320a-7a(a)(6). It covers any person who arranges or contracts, by employment or otherwise, with someone the person knows or should know is excluded, to provide items or services payable by a federal health care program. OIG's rule is at 42 CFR 1003.200(b)(4).

Under 42 CFR 1003.210, OIG may impose a penalty of up to $20,000 for conduct after February 9, 2018, for each item or service furnished by the excluded person. OIG may also add an assessment of up to 3 times the amount claimed. For services that are not billed separately, the assessment can be up to 3 times the total costs of the excluded person, including salary, benefits, and taxes. OIG may also exclude the employer.

These amounts are adjusted for inflation each year. As of October 2026, the eCFR table at 45 CFR 102.3 lists a 2025 maximum of $25,595 per item or service for employing or contracting with an excluded individual.

How often to check

OIG is direct about this. In the 2013 bulletin, OIG says providers are not required by statute or regulation to check the LEIE, so they may decide how often to check. OIG then says it updates the LEIE monthly, so screening employees and contractors each month best minimizes potential overpayment and penalty liability. OIG's exclusions page says health care entities should routinely check the list for new hires and current employees.

CMS rules are about state Medicaid agencies, not staffing agencies. Under 42 CFR 455.436, the state Medicaid agency must check the LEIE and the federal debarment list (EPLS, now part of SAM.gov) no less than monthly for the providers it enrolls. In a 2009 letter to state Medicaid directors (SMDL #09-001), CMS told states they should require Medicaid providers to search the OIG list monthly for their own employees and contractors.

So a monthly check may be required by your state Medicaid program, by the facility's contract, or by the facility's own policy. Read both.

Check before the first shift.
Recheck every worker monthly, after the LEIE update.
Follow any shorter interval in your facility contracts or state Medicaid rules.

How to search the LEIE

The online search checks up to 5 names at a time. If a name matches, OIG says to take the final step of verifying the match with the person's Social Security number. OIG says a matching first and last name alone is not enough. The online tool uses the SSN you enter to check the match. It does not show SSNs.

For larger groups, download the full LEIE as a CSV file, or add the monthly supplement files to your copy. The download has no SSNs, so any possible match must still be verified through the online search. OIG says there are no plans for a public API.

Search current and former names, such as maiden names. OIG says the list shows only the name known when the person was excluded.
Search hyphenated names under each part as well as the full name.
Use the first few letters of the first and last names for broader results.
Use the site's Print Search Results button. OIG says the browser's print function will not work.

SAM.gov and state Medicaid exclusion lists

SAM.gov is run by the General Services Administration. OIG says SAM includes OIG's exclusions plus debarment actions taken by other federal agencies. OIG recommends the LEIE as the primary source for OIG exclusions because it is updated monthly and has more detail. OIG also notes it has no authority to impose penalties for employing someone who is only debarred. Many facilities still ask for a SAM.gov check, so read your contracts.

Some states keep their own Medicaid exclusion or termination lists. In SMDL #09-001, CMS said states with such lists should remind providers to search the state list routinely whenever they search the LEIE. Search the list for each state where your workers are placed.

OIG LEIE: exclusions by HHS-OIG.
SAM.gov exclusions: federal debarments and exclusions, including OIG's.
State Medicaid lists: state-level exclusions or terminations, where a state keeps one.

What to document, and what to do with a match

OIG says to keep documentation of the initial name search, such as a printed screen showing the results, and of any further searches done to verify a possible match. Keep this for every worker, every check.

If you get a match, verify it with the SSN before acting. If it is confirmed, do not place the worker on any assignment payable by a federal health care program, and tell the affected facilities. OIG's FAQ says to review the 2013 bulletin when a match is found. For providers that already employed an excluded person, OIG points to its Provider Self-Disclosure Protocol. Talk to a health care attorney about next steps.

Worker's name, any former names, and date of birth used.
Lists checked (LEIE, SAM.gov, each state list) and the date of each check.
Results, with a saved screen or printout.
For any possible match: the SSN verification result and who reviewed it.
The date of the next scheduled check.

Common questions

Is monthly exclusion screening a federal requirement for staffing agencies?

OIG says no statute or regulation requires providers to check the LEIE, but that checking monthly best minimizes liability. The federal monthly rule at 42 CFR 455.436 applies to state Medicaid agencies. Your state Medicaid program or facility contracts may require monthly checks.

Can the hospital rely on our agency's screening?

OIG says a provider may rely on screening done by a staffing agency. OIG recommends the provider validate it, for example by requesting and keeping the agency's screening records. Expect facilities to ask for them.

What is the penalty for using an excluded nurse?

Under 42 CFR 1003.210, up to $20,000 per item or service for conduct after February 9, 2018, adjusted annually for inflation, plus an assessment of up to 3 times the amount claimed or related costs. The 2025 inflation-adjusted maximum listed in 45 CFR 102.3 is $25,595. OIG may also exclude the employer.

Do we need to check SAM.gov if we check the LEIE?

OIG calls the LEIE the primary source for OIG exclusions. SAM.gov also lists debarments by other federal agencies. Many facility contracts ask for both, so check your contracts.

Is a name match on the LEIE enough to reject someone?

No. OIG says a matching first and last name is not enough. Verify the match with the person's SSN using the online search.

When an exclusion period ends, can the person work again?

Not automatically. OIG says reinstatement is not automatic. The person must apply and get written notice from OIG. Reinstated people are removed from the LEIE.

Sources

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