OIG Exclusion Check & Medicare Opt-Out Screen - Bulk NPI LEIE

Screen a list of NPIs against the HHS-OIG List of Excluded Individuals/Entities (LEIE) and the CMS Medicare opt-out list in one run. Matching is by NPI, using the official bulk files downloaded fresh each run. You can also add provider names: a name that equals an LEIE entry without an NPI is flagged in a separate "possible match - verify" field. It is never reported as a confirmed exclusion.

• ✅ Exact NPI matching against the full current LEIE (84,093 exclusions in the October 2026 file, 8,924 of them with an NPI) and the Medicare Opt Out Affidavits file (58,286 NPIs).
• 🔎 Optional name check for the many LEIE entries that have no NPI. Results are labeled possible match - verify.
• 🧮 Offline NPI format check (check digit). Invalid NPIs are flagged and free.
• ⚡ Fast and light: 100,000 NPIs screened in about 37 s in a local test, with no per-record API calls.
• 💲 $3.00 per 1,000 screened entries ($0.003 each). No start fee.

⚠️ Not an official verification. This is a screening aid built from public government files. Confirm any match with OIG's own LEIE online search: https://exclusions.oig.hhs.gov/ (it can verify identity by SSN/EIN, which the public file does not contain). This Actor is not affiliated with or endorsed by HHS, the HHS Office of Inspector General (OIG), or CMS. Not legal advice.

What does it do?

1. Downloads the current OIG LEIE UPDATED.csv and the current CMS Medicare Opt Out Affidavits CSV, once per run, with retries.
2. Cleans and de-duplicates your NPIs and checks each NPI's check digit offline.
3. For each valid NPI: looks it up by NPI in both files.
4. For each name you supply (person or organization, ideally with a state): looks for LEIE entries without an NPI with the same name. Persons match on last name + first name (+ state). If both records have a middle initial, they must agree. Organizations match on the name with suffixes such as LLC/INC removed (+ state).
5. Saves one row per unique NPI or name, with a plain-language screen_result.

It does not call the NPPES NPI Registry API, and it does not return provider addresses, phones or taxonomies from NPPES. It only screens against the two lists.

Who is it for?

Credentialing and compliance teams, billing companies, staffing agencies, pharmacies, home-health and DME suppliers, and health-tech platforms that need a monthly or on-hire screen of many NPIs, before confirming hits at OIG.

Input

Field	Type	Description
npis	list of strings	10-digit NPIs, one per line. Spaces and dashes are removed, and duplicates are screened once.
providers	JSON array (optional)	Name checks: {"firstName","middleName","lastName","state","npi"} for a person or {"organizationName","state","npi"} for an organization. npi attaches the name to that NPI's row. state is strongly recommended (without it, the check covers all states).
npiListUrl	string (optional)	URL of a CSV or text file. Every 10-digit number in it is screened (up to 100,000 per run; the first 30 MB are read).
checkMedicareOptOut	boolean, default true	Also check the Medicare opt-out list.
includeInvalid	boolean, default true	Keep free rows for invalid NPIs so you can clean your list.
maxEntries	integer, default 0	Cap on unique entries (0 = up to 100,000).

Example:

{
  "npis": [
    "1972902351",
    "1588302186",
    "1447580105",
    "1003000126",
    "1234567890"
  ],
  "providers": [
    {
      "organizationName": "1 Best Care, Inc.",
      "state": "MN"
    }
  ]
}

Output

One row per unique NPI or name. Main fields:

• npi, valid_format, input_name, input_entity_type, input_state
• OIG by NPI (confirmed NPI match in the file): oig_excluded, oig_excluded_name, oig_excluded_general, oig_excluded_specialty, oig_excluded_city, oig_excluded_state, oig_exclusion_type (e.g. 1128b8), oig_exclusion_type_description, oig_exclusion_date, oig_reinstatement_date, oig_waiver_date, oig_waiver_state, oig_verify_url
• OIG by name only (never confirmed): oig_name_possible_match and oig_name_possible_matches[] (each with match_basis and verdict: "possible match - verify")
• Medicare opt-out by NPI: medicare_opted_out, opt_out_active_today, opt_out_effective_date, opt_out_end_date, opt_out_specialty, opt_out_state, opt_out_eligible_to_order_and_refer
• screen_result, charged, duplicate_count_in_input, checked_at, source_dates (file names and dates actually used), disclaimer, attribution

A run summary (counts, source file dates, invalid NPIs, charged rows) is saved to the key-value store as RUN_SUMMARY.

Real output sample

From a local run of the default input on 2026-10-27 at 10:20 AM CT (LEIE file dated 2026-10-09, opt-out file Opt_Out_List_September.csv dated 2026-10-23):

NPI	Name (input)	screen_result	Billed
1972902351		ON OIG LEIE by NPI - confirm at OIG online search	yes
1588302186		ON OIG LEIE by NPI - confirm at OIG online search	yes
1447580105		Medicare opt-out active	yes
1003000126		not found on OIG LEIE or Medicare opt-out list	yes
1234567890		invalid NPI format (not screened, not charged)	no
-	1 Best Care, Inc.	POSSIBLE NAME MATCH on OIG LEIE - verify, not confirmed	yes

Selected fields from 4 of those rows:

[
  {
    "npi": "1972902351",
    "valid_format": true,
    "oig_excluded": true,
    "oig_excluded_name": "101 FIRST CARE PHARMACY INC",
    "oig_excluded_general": "OTHER BUSINESS",
    "oig_excluded_specialty": "PHARMACY",
    "oig_excluded_state": "NY",
    "oig_exclusion_type": "1128b8",
    "oig_exclusion_type_description": "Entities controlled by a sanctioned individual",
    "oig_exclusion_date": "2022-03-20",
    "oig_reinstatement_date": null,
    "oig_name_possible_match": null,
    "oig_verify_url": "https://exclusions.oig.hhs.gov/",
    "medicare_opted_out": false,
    "screen_result": "ON OIG LEIE by NPI - confirm at OIG online search",
    "charged": true,
    "checked_at": "2026-10-27T15:20:59Z",
    "source_dates": {
      "oig_leie": {
        "file": "UPDATED.csv",
        "file_last_modified": "2026-10-09",
        "rows": 84093
      },
      "medicare_opt_out": {
        "file": "Opt_Out_List_September.csv",
        "file_last_modified": "2026-10-23",
        "npis": 58286
      }
    }
  },
  {
    "npi": "1447580105",
    "valid_format": true,
    "oig_excluded": false,
    "medicare_opted_out": true,
    "opt_out_active_today": true,
    "opt_out_effective_date": "2016-10-01",
    "opt_out_end_date": "2028-10-01",
    "opt_out_specialty": "Clinical Psychologist",
    "opt_out_state": "CA",
    "opt_out_eligible_to_order_and_refer": "Y",
    "screen_result": "Medicare opt-out active",
    "charged": true
  },
  {
    "npi": null,
    "input_name": "1 Best Care, Inc.",
    "input_entity_type": "organization",
    "input_state": "MN",
    "oig_excluded": null,
    "oig_name_possible_match": true,
    "oig_name_possible_matches": [
      {
        "name": "1 BEST CARE, INC",
        "middle_name": null,
        "general": "OTHER BUSINESS",
        "specialty": "HOME HEALTH AGENCY",
        "city": "SAINT PAUL",
        "state": "MN",
        "exclusion_type": "1128b5",
        "exclusion_type_description": "Exclusion or suspension under a federal or state health care program",
        "exclusion_date": "2023-05-18",
        "reinstatement_date": null,
        "waiver_date": null,
        "waiver_state": null,
        "match_basis": "name + state; LEIE entry has no NPI",
        "verdict": "possible match - verify"
      }
    ],
    "screen_result": "POSSIBLE NAME MATCH on OIG LEIE - verify, not confirmed",
    "charged": true
  },
  {
    "npi": "1234567890",
    "valid_format": false,
    "oig_excluded": null,
    "medicare_opted_out": null,
    "screen_result": "invalid NPI format (not screened, not charged)",
    "charged": false
  }
]

Pricing

$3.00 per 1,000 screened entries ($0.003 per row, pay-per-event npi-screened, no start fee).

• Charged: every row for a valid NPI or a supplied name, including clean results ("not found on OIG LEIE or Medicare opt-out list"). A clean screen is a real, useful result.
• Free: rows for NPIs that fail the format/check-digit test (charged: false).
• If a source file can't be downloaded after retries, the run fails before anything is charged.
• Your maximum cost per run is respected. The Actor stops when the next billable row would exceed it.

Examples: 1,000 NPIs is $3.00, and 10,000 NPIs is $30.00.

Data sources and credits

• U.S. Department of Health and Human Services, Office of Inspector General: List of Excluded Individuals/Entities (LEIE), downloadable database (https://oig.hhs.gov/exclusions/exclusions_list.asp). Updated monthly. Contains active exclusions only (reinstated parties are removed).
• Centers for Medicare & Medicaid Services: Medicare Opt Out Affidavits (data.cms.gov) (https://data.cms.gov/provider-characteristics/medicare-provider-supplier-enrollment/opt-out-affidavits). Updated monthly.

Both are U.S. Government works. Credit is given on every row (attribution). OIG's own pages place no license restriction on the downloadable LEIE and recommend downloading it for checking many names. data.cms.gov states its data is public domain with attribution appreciated and no implied endorsement. Quotes are in TERMS.md.

Limitations

• Not an official verification. OIG requires final identity verification by SSN/EIN in its online search, and the public file has no SSNs or EINs.
• Name-only matches are weak. Common names produce false positives, and a missing state widens the search to all states. Treat them only as leads to check at OIG.
• The file lags. LEIE is updated monthly (it holds actions through the prior month), and the opt-out file is monthly. Recent exclusions or reinstatements may not appear yet. source_dates shows the files used.
• Exclusions only. This does not cover state Medicaid exclusion lists, the SAM.gov debarment list, licensure, or NPPES status.
• A valid format doesn't mean the NPI is real or active. NPIs are not looked up in NPPES.
• Up to 100,000 entries per run.

FAQ

Why not also return NPPES details? NPPES asks that bulk NPI Registry queries use its downloadable file rather than the API, so this Actor makes no NPPES calls. Is a possible match - verify an exclusion? No. It means an LEIE entry with no NPI has the same name (and state). Verify it at https://exclusions.oig.hhs.gov/.