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Healthcare Sanctions Check & Exclusion Screening
A single missed match of an excluded provider can put patients, revenue, and your compliance program at risk. Healthcare organizations turn to ProviderTrust to run their exclusion and sanction screening processes, backed by enhanced primary source data, exact-match results, and a screening workflow built to fit how your team already works.
exclusions discovered by ProviderTrust
people and entities monitored daily
of exclusions found only with our enhanced primary source data
OVERVIEW
An exclusion and sanction screening process verifies whether an individual or entity appears on a federal or state list of parties barred from participating in healthcare programs. That includes the HHS-OIG List of Excluded Individuals/Entities (LEIE), the General Services Administration’s System for Award Management (SAM.gov), all state Medicaid exclusion and sanction lists, and the CMS Preclusion List, along with sources like the Medicare Opt Out list and OFAC’s SDN and Non-SDN lists.
These lists exist for good reason. Exclusions may come from criminal convictions related to healthcare fraud, patient abuse or neglect, and other serious offenses. An excluded individual or entity cannot lawfully bill federal healthcare programs, and organizations that unknowingly employ, contract with, or bill for an excluded party can face significant financial and reputational consequences. Screening for exclusions and sanctions both before onboarding and on an ongoing basis after is one of the most foundational steps a healthcare compliance program can take.
Exclusion and sanction screening covers a wide variety of individuals and entities:
WHY IT MATTERS
Exclusion and sanction screening protects more than your compliance program. It protects the patients you serve, the revenue your organization depends on, and the trust that regulators and clients place in your organization. A thorough check gives compliance, human resources, and provider operations teams reassurance and a clear, auditable record of due diligence.
For most organizations, the goal isn’t just passing an audit. It’s building a screening process that’s accurate, defensible, and easy to maintain as your population grows.
COMMON CHALLENGES
Even well-resourced compliance teams run into the same set of challenges when it comes to exclusion screening. Databases live in different places, update on different schedules, and use inconsistent formatting, which makes it difficult to build one clean, reliable view of risk. That often includes:
The good news is these are solvable problems, and most healthcare organizations don’t need to grow their team to solve them. They need a monitoring partner with better data and a more reliable matching process.
HOW WE HELP
ProviderTrust’s exclusion and sanction screening runs your population against the full range of federal and state sources, then enhances your data with unique identifiers to return exact-match results. From the moment you turn on exclusion and sanction screening, your data becomes more accurate than the primary source itself: ProviderTrust has discovered more than 55,000 exclusions to date, and 44% of what we catch is found only through our enhanced primary source data — matches other vendors miss entirely.
What we screen against:
Client Testimonials
“Our data is so much better than it was. We’re more confident in our screenings. We are able to act more quickly. We’re more efficient.”
“In a short period of time, ProviderTrust’s guidance and expertise has simplified our day-to-day operations and improved our overall business, but more importantly, it’s allowed us to focus on achieving our mission ‘To Improve the Oral Health of All.”
“With ProviderTrust, we’ve reduced so much manual work that it has freed up time for our team to focus on additional compliance initiatives that, historically, we just didn’t have enough resources to address. We didn’t have to add staff to get the compliance oversight we always needed.”
“Before we met ProviderTrust, we did everything manually and we worked closely with our Human Resources department and Credentialing but the main thing is we didn’t have a centralized process or system where we can just gather all our information and all get the same information at the same time and that was really a big challenge.”
“Not only has ProviderTrust saved us countless hours of unnecessary work and delivered peace of mind that no exclusions will be missed, but their solution is also the most polished one that we work with.”
“Prior to ProviderTrust, we were manually tracking all of our primary source verification for hospital staff. It’s definitely taken a load off of our team. ProviderTrust has helped a lot with uncovering discrepancies in our data as well as building a process for the long term that can be used to avoid those data discrepancies.”
A healthcare sanction check is the process of screening individuals and entities against federal and state databases to identify sanctions, exclusions, or disciplinary actions that could affect their ability to participate in healthcare programs.
Healthcare exclusion screening verifies whether employees, providers, or vendors appear on exclusion lists such as the HHS-OIG LEIE or state Medicaid exclusion lists. It’s essential for preventing improper payments, maintaining regulatory compliance, and keeping patients safe.
Most organizations should screen new hires, providers, and vendors before onboarding, then continue screening at regular intervals afterward to stay aligned with federal guidance. But periodic checks still leave gaps between scans, and a new exclusion or sanction can surface at any point in between. Ongoing monitoring closes that gap by tracking changes continuously, so your organization catches a new exclusion the moment it’s issued rather than waiting for the next scheduled screen.
ProviderTrust reduces manual work, improves match accuracy through data enrichment, and gives compliance teams a clearer, more defensible view of potential risk across their entire population.
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