What Surveyors Look For in Your OIG Exclusion Screening Logs (42 CFR § 1001.1901)

Surveyors and auditors from federal and state agencies routinely review exclusion screening documentation during compliance evaluations. Under 42 CFR § 1001.1901, federal healthcare programs may not pay for items or services furnished, ordered, or prescribed by excluded individuals or entities. Exclusion screening logs serve as documentary evidence that a practice is taking steps to prevent non-payable claims and associated enforcement exposure.

This article explains the regulatory framework governing the effect of exclusion, clarifies how enforcement arises under the Civil Monetary Penalties Law, and outlines what surveyors typically expect to see when reviewing exclusion screening logs. It also provides a case study, a self-audit checklist, common pitfalls, and practical documentation practices for small healthcare organizations.

Small healthcare practices are subject to the same exclusion-related payment rules as larger organizations. Although resources may be limited, surveyors do not adjust expectations based on practice size when reviewing exclusion screening documentation.

Exclusion screening logs are frequently requested during audits because they provide tangible evidence that a practice is attempting to avoid submitting non-payable claims. Logs that are incomplete, inconsistent, or poorly documented may raise concerns about whether excluded individuals were involved in services connected to federal healthcare program claims.

Understanding what exclusion rules require, and what they do not, is essential to maintaining defensible documentation.

Regulatory Overview

Effect of Exclusion Under 42 CFR § 1001.1901

42 CFR § 1001.1901 establishes the scope and effect of exclusion from participation in federal healthcare programs. The regulation provides that:

• Exclusions apply to Medicare, Medicaid, and all other federal healthcare programs.

• No payment may be made for items or services furnished by an excluded individual or entity after the effective date of exclusion.

• Payment is also prohibited for items or services furnished at the medical direction of, or on the prescription of, an excluded individual when the furnishing party knew or had reason to know of the exclusion.

• Excluded individuals may not submit claims or take assignment of claims during the exclusion period.

The regulation addresses payment eligibility, not documentation formats or screening frequency.

Enforcement Under 42 CFR Part 1003

When non-payable claims are submitted or other exclusion-related violations occur, enforcement authority arises under 42 CFR Part 1003, the Civil Monetary Penalties Law. Potential consequences may include:

• Civil monetary penalties

• Assessments tied to the value of improper claims

• Repayment obligations

• Program exclusion in certain circumstances

Surveyors reviewing exclusion screening logs are primarily assessing whether a practice can demonstrate reasonable diligence in preventing non-payable claims.

Exclusion screening logs are not explicitly mandated by regulation; however, they are widely used as evidence of compliance efforts. Surveyors generally treat undocumented screening activities as if they did not occur.

Well-maintained logs help a practice demonstrate that it is actively monitoring who is involved in services connected to federal healthcare program claims and responding appropriately when issues arise.

Surveyors commonly look for the following elements when reviewing exclusion screening documentation:

• Evidence of pre-engagement or pre-employment screening

• Periodic re-screening of individuals involved in claim-related activities

• Clear identification of who performed the screening and when

• Documentation of follow-up actions when potential matches are identified

• Consistent record retention practices

Logs should be understandable, internally consistent, and readily available upon request.

A multi-specialty clinic was audited by state Medicaid surveyors. When asked to produce exclusion screening logs, the clinic provided a spreadsheet listing employee names without dates, screening results, or reviewer identifiers.

Further review identified that one administrative staff member had been excluded months earlier. Because the clinic could not demonstrate documented screening efforts, claims associated with that individual were reviewed and repayment obligations followed, along with additional enforcement scrutiny.

Key Takeaway

Incomplete logs undermine a practice’s ability to demonstrate diligence, even when informal screening may have occurred.

1. Identify Covered Roles
    Determine which individuals and entities are involved in furnishing, ordering, prescribing, or billing items or services paid by federal programs.

2. Perform Screening Activities
    Review relevant exclusion information for those individuals.

3. Document Each Review
    Record the date, individual reviewed, reviewer, and outcome.

4. Address Potential Matches
    Document follow-up actions and final determinations.

5. Retain Records
    Store logs securely and consistently for future review.

Incomplete Entries

Logs that list names without dates or results provide little evidentiary value.

One-Time Reviews

Exclusion status can change; relying only on initial checks creates gaps.

Ignoring Non-Clinical Roles

Administrative and support functions may still be connected to claims.

Poor Retention Practices

Lost or inconsistent records weaken compliance defenses.

Best Practices for Small Practices

• Use a standardized log format

• Integrate documentation into onboarding workflows

• Centralize storage for ease of access

• Periodically review logs for completeness and accuracy

These practices help ensure logs remain clear and defensible during audits.

Exclusion screening documentation reflects a practice’s broader approach to compliance. When leadership emphasizes accuracy, consistency, and accountability, staff are more likely to treat logs as an essential compliance function rather than an administrative afterthought.

Under 42 CFR § 1001.1901, payment is prohibited for items or services furnished, ordered, or prescribed by excluded individuals or entities. Although the regulation does not mandate specific screening logs, surveyors routinely expect documented evidence demonstrating efforts to prevent non-payable claims.

By maintaining clear, consistent exclusion screening logs and avoiding common documentation pitfalls, small practices can better withstand regulatory scrutiny and reduce enforcement risk.

Compliance should be a living process. By leveraging a regulatory tool, your practice can maintain real-time oversight of requirements, identify vulnerabilities before they escalate, and demonstrate to both patients and payers that compliance is built into your culture.

• U.S. Department of Health & Human Services, Office of Inspector General. 42 CFR 1001.1901 – Effect of Exclusion

• U.S. Department of Health & Human Services, Office of Inspector General.

• Centers for Medicare & Medicaid Services.

• Federal Register. 42 CFR Part 1003 – Civil Money Penalties