Medicaid Exclusion Screener — OIG LEIE + State (NY OMIG) NPI/Name Check

Screen provider names and NPIs against a merged, deduped Medicaid/Medicare exclusion list — the federal OIG LEIE (HHS-OIG List of Excluded Individuals/Entities) plus state Medicaid exclusion lists (New York OMIG live; more states scaffolded) — in one keyless actor.

Two modes:

• Search — browse/filter the merged exclusion list by name, NPI, or state.
• Screen (verdict) — hand it a batch of {name?, npi?} targets and get an excluded yes/no verdict per target, plus which list matched and a match confidence (exact-NPI, exact-name, or fuzzy-name). This is the compliance workflow and the primary MCP tool surface.

Screening/research tool over public government lists. Not a certified OIG/SAM screening service and not compliance or legal advice — always confirm any hit against the primary source list before acting.

Who it's for

• Healthcare credentialing & provider enrollment teams verifying practitioners aren't excluded.
• Payer, pharmacy, and MSO compliance teams — CMS requires monthly exclusion screening of employees, contractors, and vendors.
• Revenue-cycle / billing vendors avoiding claims tied to excluded providers.
• AI agents doing due-diligence: call this as a tool to check a name or NPI on demand.

Example input (screen mode)

{
  "mode": "screen",
  "targets": [
    { "name": "Jane Q Provider", "npi": "1234567890" },
    { "npi": "1972902351" },
    { "name": "Gregory Testington" }
  ],
  "fuzzyThreshold": 0.85
}

Each target returns one or more verdict rows: excluded: true with the matching list + confidence, or a single excluded: false row when nothing matches on any loaded list.

Example input (search mode)

{
  "mode": "search",
  "npi": "1972902351"
}

Other search filters: name (contains + fuzzy), state (e.g. NY).

Output fields

Each dataset row includes: screened_input, list_source (OIG-LEIE / NY-OMIG / …), excluded, last_name, first_name, middle_name, business_name, npi, license_number, exclusion_type, exclusion_date, reinstatement_date, waiver_date, specialty, general_category, address, city, state, zip, match_type (exact-npi / exact-name / fuzzy-name / no-match), match_confidence (0–1), source_url, retrieved_at.

Sources

Key	List	Format	Source
OIG-LEIE	Federal HHS-OIG List of Excluded Individuals/Entities	CSV	oig.hhs.gov/exclusions
NY-OMIG	New York State OMIG Medicaid Exclusions	tab-delimited	omig.ny.gov
CA-MEDI-CAL	California DHCS Medi-Cal S&I (scaffolded)	—	files.medi-cal.ca.gov
TX-OIG-HHSC	Texas HHSC-OIG Exclusions (scaffolded)	—	oig.hhs.texas.gov

Adding a new state = one config block (url, delimiter, column map). Use the lists input to restrict which lists load.

Use as an MCP tool

This actor is callable by AI agents (Claude, Cursor, etc.) via mcp.apify.com. Its input/output schemas are field-described so an agent can screen a name or NPI and read back a structured excluded verdict with list_source and match_confidence — a clean, chainable compliance-check tool.

Pricing

Pay-Per-Event: one dataset record (one exclusion match or one screen verdict) is the billable unit. Empty screens cost only the tiny actor start.

FAQ

How do I check if a provider is excluded from Medicare/Medicaid? Run mode: "screen" with the provider's name and/or NPI in targets; the verdict row's excluded field is your answer, with list_source and match_confidence.

Does it cover the federal OIG LEIE and state Medicaid exclusion lists? Yes — the federal OIG LEIE plus state lists (New York OMIG live; California and Texas scaffolded for a later release), merged and deduped.

Can I match on NPI as well as name? Yes. Exact NPI match returns confidence 1.0; names match exact or fuzzy (typo-tolerant) with a confidence score and a tunable fuzzyThreshold.

Is this an official OIG screening / compliance determination? No. It screens public government lists for research and due diligence. Confirm any hit against the official source before making an employment, enrollment, or payment decision.