OIG exclusion screening for home health and in-home care agencies

If your agency bills Medicare or Medicaid — including Medicaid waiver and in-home care programs — every caregiver, aide, nurse, and office employee on your roster needs to be screened against the OIG List of Excluded Individuals and Entities (LEIE). The stakes are not abstract: OIG can impose civil monetary penalties of up to $10,000 for each claimed item or service furnished by an excluded person, plus an assessment of up to three times the amount claimed. For an aide who works daily shifts for months before anyone notices, that math gets ugly fast. ExclusionWatch turns screening into a ten-minute setup and an automatic monthly habit — with the documentation trail a surveyor actually wants to see.

Why home health agencies get caught out

Home health and in-home care agencies face a harder screening problem than a physician practice, for three structural reasons:

• Most of your workforce has no NPI. Caregivers, home health aides, and personal care attendants usually can't be verified with a clean NPI lookup. Screening them means name matching against roughly 80,000 active exclusions — and common names generate false positives unless you can narrow matches with a date of birth.
• Turnover is constant. A caregiver hired on the 5th and staffed on the 6th may never have been screened at all if your process is "someone checks the list quarterly." The safe pattern is to screen at hire and monthly — exclusions are added to the LEIE every month, so a clean check at hire doesn't stay clean forever.
• Nobody owns it, so nothing gets documented. In an agency of 15 to 100 staff, the administrator is also the HR department, the scheduler, and the billing team. Even when checks happen, there's often no record of who ran them, when, or how a near-match was cleared — which, in an audit, is nearly as bad as not checking.

If you're currently screening by hand, our guide to screening employees against the OIG exclusion list walks through the manual process — and why most agencies eventually automate it.

How ExclusionWatch fits an agency's workflow

1. Load your roster once

Export your staff list from your scheduling or payroll system and import it as a CSV. Names are required; dates of birth are optional but strongly recommended for caregivers without NPIs, because a DOB cuts false positives dramatically. Setup takes about ten minutes.

2. Screening runs itself every month

ExclusionWatch screens your entire roster automatically right after OIG republishes the LEIE each month, using exact, fuzzy, and NPI matching. You get an email whether the run is clean or flags potential matches — no calendar reminder, no "did anyone do this?"

3. Review flags without re-litigating them

When a name is close to an excluded person, you review the match once, record why it isn't your employee, and ExclusionWatch remembers the resolution. The same false positive won't come back next month asking to be cleared again — a real time-saver when your roster includes common names.

4. New hires slot in anytime

Add a new caregiver to the roster the day they're hired and run an on-demand screening immediately — then they're covered by every monthly run going forward. Hiring mid-month never leaves a gap.

What a surveyor wants to see

State survey teams and payer auditors increasingly ask a specific question: show me your exclusion screening documentation. A verbal "we check the list" doesn't satisfy them. What does is a timestamped report showing:

• Exactly who was screened, on what date
• Which version of the LEIE dataset the roster was screened against
• Every potential match that was flagged, and how it was resolved — including the reasoning for clearing a false positive

ExclusionWatch generates that report automatically with every run, so a surveyor's request becomes a download instead of a scramble. See a sample audit report to check it against what your surveyors ask for.

Frequently asked questions

Do caregivers without an NPI get screened?

Yes. Most exclusion records are matched by name, not NPI. ExclusionWatch uses exact and fuzzy name matching for every roster entry, and adding a date of birth — which you already have from onboarding paperwork — sharply reduces false positives for common names.

What about new hires mid-month?

Add them to your roster anytime; they're automatically included in the next monthly run. If you want coverage from day one — and for new hires, you should — run an on-demand screening the day they're added. You can also check a single name instantly with our free exclusion check tool before you even extend an offer.

How big a roster can I screen?

Plans cover 25 entries at $49/month, 100 at $99/month, and 500 at $149/month — which spans everything from a small in-home care agency to a multi-branch operation. Full details are on the pricing page.

What happens if a screening finds a real match?

You get an email alert immediately, with the exclusion record details so you can verify the match and act. Confirming a true exclusion means removing that person from federally funded work and talking to your compliance counsel — but finding it in this month's run, rather than in next year's audit, is the entire point.