Medicare exclusion list
Medicare exclusion list lookup and OIG LEIE verification
Start Medicare exclusion list review with the HHS OIG LEIE, then confirm any possible match in official OIG systems before making a payment, employment, contracting, credentialing, or enrollment decision.
Public list
OIG LEIE
OIG says the LEIE covers current exclusions from Medicare, Medicaid, and other federal health care programs.
Latest public file
05-2026 LEIE
OIG displayed a 2026-06-10 Last Update for the active-exclusions download when checked.
Review limit
Verify at source
SourceCheckHealth is a screening aid and does not provide legal clearance or final credentialing decisions.
Definition-first source note
What is the Medicare exclusion list?
As of 2026-08-11, the public Medicare exclusion list workflow starts with the HHS OIG LEIE: OIG describes the LEIE as the list of individuals and entities currently excluded from participation in Medicare, Medicaid, and all other federal health care programs, and its public downloads page showed a 2026-06-10 Last Update for the 05-2026 Updated LEIE Database.
CMS separately describes a Medicare Exclusion Database used inside Medicare operations. That CMS system receives excluded-provider information from OIG on a monthly basis and shares data with approved Medicare contractors, law-enforcement users, state Medicaid agencies, and other CMS applications. Public screening teams should still begin with the OIG LEIE search or download and document the official verification source they used.
Definition-first source note
Does a Medicare exclusion end when its term runs out?
No. As of 2026-08-11, an exclusion does not lapse on its own when the period stated in the notice of exclusion expires: 42 CFR 1001.3002(d) says reinstatement “will not be effective until the OIG grants the request and provides notice.” The excluded party has to ask — 42 CFR 1001.3001(a)(1) lets them submit a written request for reinstatement only after the date specified in the notice, and states plainly that “obtaining a program provider number or equivalent does not reinstate eligibility.” OIG then authorises reinstatement only if the period has expired, there are reasonable assurances the conduct has not recurred and will not recur, and no additional basis for exclusion exists (§ 1001.3002(a)).
That is why a name whose exclusion date is more than five years old can still be an active row: the minimum period is the earliest an application may be filed, not an expiry date. It is also why a stored screening result ages. Re-screen against the current LEIE file rather than reasoning from an exclusion date, and confirm any possible match in official OIG systems before acting.
Source: 42 CFR part 1001, subpart F, text current as of 2026-08-01. date_retrieved: 2026-08-11.
Mandatory vs permissive
How long a Medicare exclusion lasts, by authority
Every LEIE row carries an EXCLTYPE code naming the Social Security Act authority behind the exclusion. SourceCheckHealth decodes the leading section only as mandatory (1128(a)) or permissive (1128(b)) — the regulation below is what those two categories mean for the length of the exclusion.
| Authority | Regulation | Typical basis | Minimum period |
|---|---|---|---|
| Mandatory — section 1128(a) | 42 CFR 1001.101 | Conviction for a program-related crime, patient abuse or neglect, a post-August 1996 felony involving health care fraud or other financial misconduct, or a post-August 1996 felony involving a controlled substance. | Never less than 5 years“No exclusion imposed in accordance with § 1001.101 will be for less than 5 years.” (§ 1001.102(a)) |
| Permissive — section 1128(b) | 42 CFR 1001.201 | Conviction of a misdemeanor relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct in health care, or comparable misconduct in another government-funded program. | 3 years by defaultSet at 3 years “unless aggravating or mitigating factors … form a basis for lengthening or shortening that period.” (§ 1001.201(b)(1)) |
Both baselines move. Under § 1001.102(b) aggravating factors — a financial loss of $50,000 or more, conduct over a year or more, a sentence including incarceration, a prior sanction record — lengthen a mandatory exclusion, and § 1001.102(c) allows mitigating factors to be weighed only once an aggravating factor has already pushed the term past five years. A permissive exclusion under § 1001.201 can be shortened as well as lengthened. Read the exclusion notice itself for the period that actually applies to a given person or entity.
Source: 42 CFR part 1001, subparts B and C, text current as of 2026-08-01. date_retrieved: 2026-08-11.
Official search path
Use the LEIE for public Medicare exclusion review
- 1. Search strongest identifiers first. Use NPI when present, then names, business names, city, state, ZIP, and exclusion type.
- 2. Confirm possible matches in OIG. OIG notes that the downloadable file does not contain SSNs or EINs, so identity verification for specific people or entities belongs in the official online search.
- 3. Preserve source freshness. Record the LEIE file month, OIG Last Update date, and date_retrieved before acting on a screening result.
Payment context
Why Medicare checks excluded providers
The CMS Medicare Learning Network booklet Medicare Fraud & Abuse: Prevent, Detect, Report (MLN4649244, April 2026) says an OIG exclusion means federal health care programs do not pay for items or services provided, ordered, or prescribed by an excluded person or entity, and that they also do not pay the excluded person or anyone who employs or contracts with them. The exclusion applies regardless of who submits the claims.
That payment rule is why Medicare exclusion list review should be source-backed and repeatable. Use SourceCheckHealth to reach candidate public rows and official links, then document the OIG verification step outside the site.
date_retrieved: 2026-08-09.
Medicare exclusion list source comparison
Which source should reviewers use?
| Source | Access | Best use | Identifier note |
|---|---|---|---|
| Public OIG LEIE | Online search and downloadable CSV | Current public exclusion screening and review triage | Downloadable files omit SSNs and EINs; use official OIG online verification for identity confirmation. |
| CMS Medicare Exclusion Database | CMS-controlled internal application and files | Medicare program operations and payment-integrity workflows | CMS describes the system as receiving OIG exclusion information monthly and sharing it with approved users. |
| SourceCheckHealth imported index | Public state/detail pages and batch-screening context | Finding candidate rows, source dates, and official links before manual verification | Use as a screening aid only; confirm current status in official OIG systems before acting. |
Continue review
Open the related OIG review paths
date_retrieved: 2026-06-15. This page is public-source screening guidance only and does not provide legal advice, complete credentialing, licensure verification, Medicare enrollment status, or a final hiring or contracting decision.
FAQ
Practical notes
Is the Medicare exclusion list the same as the OIG LEIE?
For public screening, use the HHS OIG LEIE. OIG says the LEIE includes individuals and entities currently excluded from Medicare, Medicaid, and other federal health care programs. CMS also operates a Medicare Exclusion Database for approved Medicare program users.
How often is Medicare exclusion list data updated?
OIG says LEIE versions are generally updated by the middle of each month and include actions from the prior month. Check the source status and the official OIG downloads page before relying on a screening result.
Can SourceCheckHealth confirm a Medicare exclusion match?
No. SourceCheckHealth helps reviewers find imported public rows, source dates, and official links. Confirm any possible match in the official OIG online search or current LEIE download before acting.
How long does a Medicare exclusion last?
It depends on the authority recorded in the LEIE row's EXCLTYPE code. A mandatory exclusion under section 1128(a) has a floor: 42 CFR 1001.102(a) says no exclusion imposed under 42 CFR 1001.101 will be for less than 5 years. A permissive exclusion under 42 CFR 1001.201 is set at 3 years unless aggravating or mitigating factors lengthen or shorten it. Aggravating factors in 42 CFR 1001.102(b) — a financial loss of $50,000 or more, conduct spanning a year or more, a sentence including incarceration, a prior sanction record — push a mandatory term above the 5-year floor, and mitigating factors may be weighed only after an aggravating factor has already done so. The period that applies to a specific person or entity is the one stated in their notice of exclusion. (42 CFR part 1001, text current as of 2026-08-01; retrieved 2026-08-11.)
How does someone get off the Medicare exclusion list?
Not by waiting. Under 42 CFR 1001.3001(a)(1) an excluded individual or entity may submit a written request for reinstatement to OIG only after the date specified in the notice of exclusion, and the same paragraph states that obtaining a program provider number or equivalent does not reinstate eligibility. OIG authorises reinstatement under 42 CFR 1001.3002(a) only where the period has expired, there are reasonable assurances the conduct has not recurred and will not recur, and no additional basis for exclusion exists — and 42 CFR 1001.3002(d) says reinstatement is not effective until OIG grants the request and provides notice. So an exclusion date more than five years old does not mean the row is stale; re-screen against the current LEIE file instead of inferring status from the date. (Retrieved 2026-08-11.)