Federal and state governments require healthcare providers who bill government programs including, without limitation, Medicare and Medicaid to check the names of all providers, staff and agents/vendors against specific exclusionary databases according to certain time frames.
Exclusionary Databases that must be checked monthly
Exclusionary Databases that must be checked when a provider is credentialed or re-credentialed
- U.S. Treasury’s Office of Foreign Assets Control Specially Designated Nationals (SDN List)
- U.S. Centers for Medicare and Medicaid Services National Plan & Provider Enumeration System (NPPES)
- U.S. Social Security Death Master File (Death Master)
If a match is found on any exclusionary database, the provider, staff member or agent/vendor should immediately be suspended. That person should be given the opportunity to appeal to the appropriate government agency to have his or her name removed from the database, or receive a waiver from them.
If those actions are not successful, the person must be terminated from employment, or an agent/vendor’s contract must be terminated.
