On September 29, 2025, a home health company in Arizona, agreed to pay $20,000 to settle allegations of violating the Civil Monetary Penalties Law (CMPL). The Office of Inspector General (OIG) alleged that the home health company employed an excluded individual—someone prohibited from participating in any Federal health care program—as a home health aide. The individual’s services were allegedly billed to these programs, triggering the violation.
While $20,000 may seem modest in comparison to larger settlements, this case serves as a critical reminder of the importance of conducting monthly exclusion checks.
What Are Exclusion Checks?
Exclusion checks are routine verifications that ensure no employees, contractors, or vendors are listed on the OIG’s List of Excluded Individuals/Entities (LEIE) or the System for Award Management (SAM). Individuals or entities on these lists are barred from participation in Medicare, Medicaid, and other Federal health care programs due to prior misconduct, fraud, or other disqualifying actions.
Hiring or retaining an excluded individual—knowingly or unknowingly—can result in civil monetary penalties, repayment of claims, and reputational damage.
Why Monthly Checks Are Crucial
Healthcare organizations often perform exclusion screenings only during the hiring process. However, a one-time check isn’t enough. It can take nearly 200 days for an exclusion to appear on the LEIE and up to two years to appear on a state list. (Read more about the differences between state and federal exclusion checks here.) This means employees can become excluded after they are hired, and if a provider continues to bill for their services, it can lead to costly penalties and legal exposure.
Performing monthly exclusion checks provides several key benefits:
- Protects against inadvertent billing violations.
Regular monitoring helps ensure that no excluded individuals are contributing to claims submitted to Federal programs. - Reduces legal and financial risk.
The OIG can impose substantial fines—often $10,000 per item or service billed—for each violation. Early detection through monthly checks helps mitigate these risks. - Demonstrates compliance diligence.
Consistent screening shows a commitment to compliance and can serve as a mitigating factor if an issue arises during an audit or investigation. - Safeguards organizational integrity and reputation.
Compliance lapses can erode patient trust and tarnish a provider’s standing within the healthcare community.
Key Takeaway: Prevention Is Cheaper Than Penalties
This specific case underscores a simple truth: compliance is not optional. Even an isolated incident involving an excluded individual can result in financial penalties, administrative headaches, and reputational harm.
Implementing a robust monthly exclusion screening process—ideally automated and documented—is one of the most effective and affordable ways to maintain compliance and protect your organization from costly enforcement actions.
LW Consulting, Inc. (LWCI) provides an affordable and user-friendly exclusions software solution. LWEnSCheck® Exclusions Software is available through a monthly subscription, enabling organizations to efficiently complete their monthly exclusion checks and download detailed reports for compliance documentation. If your team finds it challenging to stay current with monthly exclusions, our experienced exclusion consultants can manage the process for you.
LW Consulting, Inc. (LWCI) offers a comprehensive range of services to assist your organization in maintaining compliance, identifying trends, providing education and training, or conducting documentation and coding audits. For more information, contact LWCI to connect with one of our experts!
| Sources: |
| HHS-OIG. (n.d.). Exclusions | Office of Inspector General | U.S. Department of Health and Human Services. https://oig.hhs.gov/exclusions/ |
| U.S. Department of Health and Human Services Office of Inspector General. (n.d.). https://oig.hhs.gov/fraud/enforcement/accucare-home-health-services-agreed-to-pay-20000-for-allegedly-violating-the-civil-monetary-penalties-law-by-employing-an-excluded-individual/ |
