There are numerous reasons an individual or entity could be excluded. Federal and state agencies sanction, suspend, exclude, or debar individuals and companies from federally funded benefit programs for a variety of reasons, including fraud, drug abuse, issues with licensure, healthcare-related misdemeanors or felonies, and defaulting on federally backed student loans. 42 states (including Washington D.C.), along with the two federal government agencies, maintain exclusion lists that are updated on a regular basis.
If a person or entity is excluded, they cannot receive direct or indirect payment from federal benefit programs. Healthcare organizations cannot make payments to such vendors or persons, without incurring a fine or penalty.
A complete list of all exclusion sources can be found here.
Exclusion Monitoring Results:
Match: The subject is confirmed to have at least one match against an exclusion record from the monitored sources.
No Match: The monitored subject is confirmed to have zero matches against any records from these sources.
Suspected Match: A possible exclusion match was found, but requires manual review to confirm identity based on available data.
Insufficient Client Data: There is not enough data (such as missing name or required identifiers) to perform a successful check.
Looking for a complete list of our monitoring services? Check out our one-stop shop for all result definitions: Understanding Your Monitoring Results.
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