Exclusion screening for staffing agencies and the facilities that use them

Why agency workers are a blind spot

Most practices screen the people on their own payroll. Agency nurses, travel therapists, locum physicians and per-diem aides often fall between two compliance programs: the facility assumes the agency checked, and the agency assumes the facility will. Workers also move between states and between agencies, which is exactly how a termination in one state goes unnoticed in another.

The federal rule doesn’t care who signs the paycheck. No federal health care program payment may be made for items or services furnished, ordered or prescribed by an excluded person, and OIG’s bulletin says that applies “regardless of whether the person is an employee, a contractor, or a volunteer” (OIG Special Advisory Bulletin, 2013). If the facility bills Medicare or Medicaid for the shift, the facility is the one paid for the excluded person’s work.

What OIG’s guidance says

OIG’s 2013 Special Advisory Bulletin on the Effect of Exclusion is still the main guidance. Four parts matter most for staffing:

1. Screen them. In the section on which people to screen, OIG says it “recommends that providers screen nurses provided by staffing agencies.”
2. You can rely on the agency, but check. Where a contractor screens on the provider’s behalf, OIG “recommends that the provider validate that the contractor is conducting such screening.”
3. Reliance helps with penalties, not with refunds. The bulletin says a hospital may reduce or eliminate its penalty liability if it reasonably relied on a staffing agency’s check, but also that the provider is subject to overpayment liability for any items or services furnished by any excluded person.
4. Monthly is the safe cadence. OIG notes that no statute or regulation requires checking the LEIE, then says screening employees and contractors each month best minimizes potential overpayment and penalty liability.

The penalty standard is whether the provider “knows or should know” the person is excluded. A documented, regular screen, by you or by an agency you have validated, is the clearest evidence that you didn’t and couldn’t have known.

Who checks what, and when

Which lists to check

• OIG LEIE. The primary source for health care exclusions, updated monthly. OIG’s online search can verify a match by Social Security number (OIG, database help).
• SAM.gov exclusions. Includes OIG’s exclusions plus debarments by other federal agencies (SAM.gov).
• State Medicaid lists. For every state where the worker has recently worked or will be placed. Traveling workers make this the list most often skipped and most often needed. Our state directory shows what each state publishes.
• The license, in each state. Not an exclusion list, but a revoked or surrendered license is a common reason for exclusion. Use our license lookup for every state, or Nursys for nurses.
• The agency itself. Screen the agency’s business name too: OIG can exclude entities, not just people.

Use every name a worker has used: OIG’s bulletin says names such as maiden names should be searched.

What a missed exclusion can cost

Each claim for an item or service by an excluded person can carry a penalty of up to $25,595 in 2026 (HHS inflation adjustment, 2026), plus an assessment of up to three times the amount claimed (42 U.S.C. 1320a-7a), on top of repaying the claims. A nurse on shift generates many items quickly, so exposure grows faster than most managers expect:

Our excluded employee cost calculator works this out for your own numbers, including the refund.

What to put in the staffing contract

These are the points most compliance teams want covered. They are not legal wording; have your lawyer adapt them to your contract and state.

For agencies: a screening program clients trust

For a staffing firm, screening is part of the product. Compliance officers at hospitals, nursing homes and home health agencies are asked by auditors how they know agency workers are clean, and the easiest answer is a record from the agency that they can file. A program that holds up has five parts.

1. Onboarding that collects what screening needs. Full legal name, every former name, date of birth, NPI if the worker has one, every license with its state and number, and every state the worker has lived or worked in during the last several years. Without former names and states, a screen can be clean and still wrong.

2. A screen before the first placement. OIG, SAM.gov, the state Medicaid lists for each of those states, and the license search for each license. Any possible match is confirmed or ruled out before the worker is offered to a client, and the reasoning is written down.

3. A monthly re-screen of everyone available for placement, not only those on assignment this week. OIG updates its list monthly and SAM.gov changes daily. Running the screen soon after OIG’s monthly update means the record uses the newest OIG data.

4. Records clients can use. For each run: the date, the lists and the date of each list’s copy, the names screened, and the outcome for each possible match. A PDF per client, listing only that client’s workers, avoids sharing one client’s staffing details with another.

5. A written response plan. Who decides when a match is confirmed, how quickly clients hear (the contract usually says), how the worker is removed, and how records are kept. Agencies should also screen their own owners and managers; an excluded owner can put every placement in question.

If a placed worker turns out to be excluded

Whether you are the agency or the facility, move quickly but in order. Acting before confirming can be unfair to the worker; waiting after confirming makes the liability grow with every shift.

1. Confirm the match. Use OIG’s online search to verify by Social Security number, or compare the NPI, date of birth and address in the record. Save what you found.
2. Stop federally paid work. The worker should not furnish items or services that Medicare, Medicaid or other federal programs pay for, directly or indirectly, while this is resolved.
3. Tell the other side in writing. Agencies tell every client where the worker was placed; facilities tell the agency.
4. Find the affected dates and claims. The exclusion’s effective date is in the record. Work out which shifts after that date were billed.
5. Hold related claims that haven’t been submitted.
6. Get legal advice before repaying or self-disclosing. OIG’s bulletin points providers to its Self-Disclosure Protocol to resolve potential penalty liability, and a lawyer can advise on refunds to Medicare and Medicaid.
7. Fix the gap. Work out why the screen missed it (a former name, a state not checked, a stale check) and change the routine.

Our excluded employee response plan goes through each step in detail.

Travelers, locums and per-diem workers

Workers who move are where screens most often miss, for three reasons. First, state lists are separate: a Medicaid termination in one state does not appear on the federal lists unless it also leads to a federal exclusion, so checking only the state of the current placement misses the states the worker came from. Second, names change: travelers who marry, divorce or use a middle name professionally may be listed under a name that isn’t on the current paperwork. Third, several agencies may place the same person, and each may assume another has checked.

For nurses in Nurse Licensure Compact states, the license that allows multistate practice is issued by the nurse’s home state; Nursys QuickConfirm shows it along with public discipline. For physicians on locum assignments, check the license in the state of each assignment as well as the home state. None of this replaces the exclusion screen: a valid license and an exclusion can exist side by side, because an exclusion can outlast a license action that was later lifted.

Four examples

The people and organizations below are invented. The rules come from the sources cited.

1. The agency’s check was a year old

A rural hospital takes a travel nurse from an agency that screened her once at hire, 13 months earlier. She was excluded six months ago after a conviction in another state. The hospital’s own monthly screen of agency workers catches it in its first week. It pulls her from the schedule, holds the claims for her shifts and calls counsel. Because it found the problem in days rather than months, the number of affected claims is small.

2. Validating the agency

A skilled nursing facility uses three agencies. Each quarter it asks each one for the dated screening records of five workers it picks at random, and compares the lists and dates with the contract. One agency checks only OIG. The facility asks it to add SAM.gov and the state lists, and in the meantime screens that agency’s workers itself.

3. A locum moving between states

A locum physician has worked in four states in three years. The agency screens OIG and SAM.gov every month, which is clean, and adds the four state lists at placement. One state shows a Medicaid termination for failing to revalidate, not for fraud. The agency tells the client, the client’s credentialing team reviews the reason, and the physician fixes the enrollment before starting. Not every state entry means misconduct, which is why reading the record matters.

4. An agency selling screening as a feature

A small staffing firm sends every client a monthly PDF record listing each worker on assignment, the lists checked and the date of each list. Clients file it with their own compliance records, and the firm uses it in sales: it answers the first question every compliance officer asks.

Questions to ask an agency before you sign

• Which lists do you screen every worker against, and how often? Do you include the state lists for every state a worker has worked in?
• Do you search former names?
• Can you send a dated record for any worker on request, and a monthly attestation for all workers placed with us?
• How quickly will you tell us about a possible or confirmed match, and how?
• Do you screen your own owners and managers?
• Will you reimburse repayments and penalties if you place an excluded worker you should have caught?

Vague answers are useful too: they tell you to run your own monthly screen of that agency’s workers.

A monthly routine that takes minutes

The bulk exclusion check is free, and the Practice Pro plan saves the roster and re-screens it every month for you, with a weekly check in between and an email the day something new turns up.

What our tools can and can’t do

• They search OIG, SAM.gov and the state lists that can be downloaded automatically, and list the states they did not search.
• They match on names, businesses and NPIs; they don’t see Social Security numbers, so confirm any possible match on the official source.
• They don’t verify licenses or employment history. Use the state boards for licenses.

Questions

Sources

1. HHS OIG, Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs (May 2013) — screening agency nurses, relying on and validating a contractor’s screening, overpayment liability, reasonable reliance and penalties, monthly screening, all names used, self-disclosure
2. CMS, State Medicaid Director Letter #09-001 (January 16, 2009): providers should search for excluded employees and contractors monthly — CMS asks state Medicaid programs to require monthly searches for excluded employees and contractors
3. HHS, Annual Civil Monetary Penalties Inflation Adjustment (Federal Register, January 28, 2026) — the 2026 maximum penalty of $25,595 per item or service
4. 42 U.S.C. § 1320a-7a (civil monetary penalties) — civil money penalties and the assessment of up to three times the amount claimed
5. HHS OIG, Background Information and Exclusion Authorities — OIG excludes individuals and entities
6. HHS OIG, Exclusions database help — confirming a match by Social Security number or EIN
7. SAM.gov, exclusions search — SAM.gov exclusions search

Checked October 27, 2026. This page is general information, not legal advice; contract terms and state Medicaid rules vary. For a confirmed exclusion, talk to a health care lawyer before repaying or self-disclosing. Examples use invented people and organizations.