Overview
A healthcare sanctions search checks whether a person has been excluded from participating in federal or state healthcare programs, or has been disciplined by a healthcare regulator.
It is one of the few screening components where the consequence of skipping it is quantifiable. An organization billing a federal healthcare program while employing an excluded person can be required to repay what was billed and can face penalties on top of that.
What Exclusion Means
Exclusion bars a person from participating in federal healthcare programs. The bar is broad: no federal program payment may be made for any item or service furnished by an excluded person, or directed or prescribed by one.
It reaches beyond direct patient care. An excluded person working in billing, administration, food service, or transportation at an organization that bills federal programs can still create exposure, because the prohibition attaches to the payment rather than to the clinical role.
Exclusion is separate from licensing. A person can hold a valid license and be excluded, or lose a license without being excluded, so this search does not substitute for credential verification.
Which Lists Are Searched
| OIG LEIE List of Excluded Individuals and Entities | Published by the Office of Inspector General at the U.S. Department of Health and Human Services. The primary source, listing everyone excluded from federal healthcare programs. Updated monthly and free to search. |
| SAM Exclusions | The System for Award Management, listing parties barred from federal contracts, grants, and assistance across every federal agency. Includes healthcare related debarments and covers parties not on the OIG list. |
| FDA Debarment List | Published by the U.S. Food and Drug Administration, listing individuals barred from working for companies with drug applications pending or approved. Relevant to pharmaceutical and clinical research employers. |
| State Medicaid exclusion lists | Published by individual state Medicaid programs. Many states maintain their own, and a person excluded at state level may not appear on the federal list. |
| Licensing board actions | Disciplinary action by state boards governing healthcare professions. |
| Abuse registries | State registries recording findings of abuse or neglect in care settings. |
The OIG list alone is not sufficient for an organization operating across states, since state exclusions are published separately and do not appear on it.
FACIS and Aggregated Searches
Searching every relevant list individually is impractical, so screening companies use aggregated products that check many sources at once. FACIS is the most widely used, and the name appears often enough that it is sometimes taken for a government database. It is a commercial product that compiles government sources.
Aggregated products are usually sold in levels, with each level covering a wider set of sources. A lower level may cover the primary federal lists, while higher levels add state exclusions, licensing actions, and additional registries.
The level determines the coverage.
Why Someone Is Excluded
Exclusions fall into 2 categories.
Mandatory exclusions are required by law and follow a criminal conviction. Four categories trigger them:
- Crimes related to the delivery of items or services under Medicare, Medicaid, or another federal healthcare program, which in practice means billing fraud
- Patient abuse or neglect
- Felony healthcare fraud, whether or not a government program was involved
- Felony offenses involving controlled substances, including diversion of medication
These carry minimum exclusion periods set by statute, with longer periods for repeat conduct.
Permissive exclusions are applied at the agency’s discretion and reach conduct that never produced a conviction. The grounds include:
- Losing or surrendering a professional license for reasons relating to competence, performance, or financial integrity
- Misdemeanor fraud, theft, or financial misconduct
- Submitting claims for excessive charges, or for services that were unnecessary or fell below professional standards
- Defaulting on health education loans or scholarship obligations
- Controlling or having a management role in an entity that has itself been excluded or convicted
The second route is why a healthcare sanctions search can find something a criminal search does not. A person who surrendered a license during an investigation may have no conviction and an exclusion.
Exclusion is not permanent in every case. A person may apply for reinstatement after the applicable period, and reinstatement is not automatic when the period ends. Someone remains excluded until reinstatement is granted.
Why the Stakes Are High
Liability does not depend on knowing. An organization that bills a federal healthcare program for items or services involving an excluded person can be required to repay those amounts and face civil monetary penalties, whether or not it was aware of the exclusion. Screening is the mechanism by which an employer avoids that exposure.
This is why healthcare employers screen more thoroughly and more often than employers in most sectors, and why the practice extends to contractors, vendors, and volunteers as well as employees.
Screening at Hire and After
A check at hire establishes the position on one day. Exclusions are added continuously, so an employee cleared at hire can be excluded later.
The federal list is updated monthly, and monthly screening of all employees and contractors is the common practice in healthcare organizations. Many use an automated arrangement to run it, which overlaps with our page on Continuous Monitoring.
What It Does Not Cover
- Criminal records, which come from a county criminal search. Conduct leading to exclusion often produces a criminal record, and the 2 searches return different information.
- License status, covered by credential verification.
- Exclusions in states not searched, where the product level does not include them.
- Sanctions and debarment outside healthcare, covered on our Global Watchlists page.
- Conduct that never resulted in exclusion or board action.
Where It Fits Under the FCRA
Sanctions results reported by a screening company for employment purposes form part of a consumer report. Written disclosure and authorization are required before the report is requested, accuracy obligations attach to what is reported, and the individual has the right to dispute anything incorrect. Our FCRA Overview covers those requirements in full.
These lists are public records maintained by government agencies, which brings additional obligations into play. Reporting an exclusion without checking whether the person has since been reinstated is the most common failure here.
Name matching carries the same risk described on our Global Watchlists page, and exclusion lists include identifying detail intended to resolve it.
Where a sanctions record contributes to a decision not to hire, the required notice steps apply. See The Adverse Action Process.