# Medicaid Exclusion Screener — OIG LEIE + State Name/NPI Check (`malonestar/medicaid-exclusion-screener`) Actor Screen names & NPIs against merged Medicaid/Medicare exclusion lists. Deduped OIG LEIE + state (NY OMIG) exclusions, name+NPI searchable, with a screen-verdict mode returning excluded yes/no, which list, and match confidence. Keyless. Screening/research tool, not compliance advice. - **URL**: https://apify.com/malonestar/medicaid-exclusion-screener.md - **Developed by:** [Kyle Maloney](https://apify.com/malonestar) (community) - **Categories:** Lead generation, Developer tools, Agents - **Stats:** 2 total users, 1 monthly users, 100.0% runs succeeded, 0 bookmarks - **User rating**: No ratings yet ## Pricing from $10.00 / 1,000 results This Actor is paid per event. You are not charged for the Apify platform usage, but only a fixed price for specific events. Learn more: https://docs.apify.com/platform/actors/running/actors-in-store#pay-per-event ## What's an Apify Actor? Actors are a software tools running on the Apify platform, for all kinds of web data extraction and automation use cases. In Batch mode, an Actor accepts a well-defined JSON input, performs an action which can take anything from a few seconds to a few hours, and optionally produces a well-defined JSON output, datasets with results, or files in key-value store. In Standby mode, an Actor provides a web server which can be used as a website, API, or an MCP server. Actors are written with capital "A". ## How to integrate an Actor? If asked about integration, you help developers integrate Actors into their projects. You adapt to their stack and deliver integrations that are safe, well-documented, and production-ready. The best way to integrate Actors is as follows. In JavaScript/TypeScript projects, use official [JavaScript/TypeScript client](https://docs.apify.com/api/client/js.md): ```bash npm install apify-client ``` In Python projects, use official [Python client library](https://docs.apify.com/api/client/python.md): ```bash pip install apify-client ``` In shell scripts, use [Apify CLI](https://docs.apify.com/cli/docs.md): ````bash # MacOS / Linux curl -fsSL https://apify.com/install-cli.sh | bash # Windows irm https://apify.com/install-cli.ps1 | iex ```bash In AI frameworks, you might use the [Apify MCP server](https://docs.apify.com/platform/integrations/mcp.md). If your project is in a different language, use the [REST API](https://docs.apify.com/api/v2.md). For usage examples, see the [API](#api) section below. For more details, see Apify documentation as [Markdown index](https://docs.apify.com/llms.txt) and [Markdown full-text](https://docs.apify.com/llms-full.txt). # README ## 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) ```json { "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) ```json { "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. # Actor input Schema ## `mode` (type: `string`): 'search' browses/filters the merged exclusion list by name, NPI, or state. 'screen' takes a batch of targets and returns an excluded yes/no VERDICT per target (the compliance use case: check your providers/vendors against the lists). ## `targets` (type: `array`): screen mode ONLY. An array of people/entities to check, each an object with an optional 'name' and/or 'npi', e.g. \[{"name":"Jane Doe","npi":"1234567890"}, {"npi":"1987654321"}]. Each target yields one or more verdict rows: excluded true (with the matching list + confidence) or a single excluded:false row when nothing matches. ## `name` (type: `string`): search mode. Case-insensitive contains + fuzzy match against provider/business names and person names across the merged list. Empty = no name filter. ## `npi` (type: `string`): search mode. Exact 10-digit National Provider Identifier to look up in the merged list. Empty = no NPI filter. ## `state` (type: `string`): search mode. Two-letter US state code (e.g. NY, CA, TX) to keep only exclusions whose recorded state matches. Empty = all states. ## `lists` (type: `array`): Optional list keys to load, e.g. \["OIG-LEIE","NY-OMIG"]. Empty = all enabled lists (currently OIG-LEIE + NY-OMIG). Scaffolded states (CA-MEDI-CAL, TX-OIG-HHSC) are disabled until their source URL/columns are confirmed at deploy. ## `fuzzyThreshold` (type: `number`): Minimum name similarity (0-1) for a fuzzy-name match to count as a hit. 1 = exact only; lower catches more typos/variants at the cost of false positives. Default 0.85. ## `maxResults` (type: `integer`): Maximum number of records to emit. One record = one billable result. ## Actor input object example ```json { "mode": "search", "targets": [ { "name": "John Smith" }, { "npi": "1972902351" } ], "fuzzyThreshold": 0.85, "maxResults": 5000 } ``` # Actor output Schema ## `results` (type: `string`): The default dataset of exclusion matches / screen verdicts. # API You can run this Actor programmatically using our API. Below are code examples in JavaScript, Python, and CLI, as well as the OpenAPI specification and MCP server setup. ## JavaScript example ```javascript import { ApifyClient } from 'apify-client'; // Initialize the ApifyClient with your Apify API token // Replace the '' with your token const client = new ApifyClient({ token: '', }); // Prepare Actor input const input = { "targets": [ { "name": "John Smith" }, { "npi": "1972902351" } ] }; // Run the Actor and wait for it to finish const run = await client.actor("malonestar/medicaid-exclusion-screener").call(input); // Fetch and print Actor results from the run's dataset (if any) console.log('Results from dataset'); console.log(`💾 Check your data here: https://console.apify.com/storage/datasets/${run.defaultDatasetId}`); const { items } = await client.dataset(run.defaultDatasetId).listItems(); items.forEach((item) => { console.dir(item); }); // 📚 Want to learn more 📖? Go to → https://docs.apify.com/api/client/js/docs ``` ## Python example ```python from apify_client import ApifyClient # Initialize the ApifyClient with your Apify API token # Replace '' with your token. client = ApifyClient("") # Prepare the Actor input run_input = { "targets": [ { "name": "John Smith" }, { "npi": "1972902351" }, ] } # Run the Actor and wait for it to finish run = client.actor("malonestar/medicaid-exclusion-screener").call(run_input=run_input) # Fetch and print Actor results from the run's dataset (if there are any) print("💾 Check your data here: https://console.apify.com/storage/datasets/" + run["defaultDatasetId"]) for item in client.dataset(run["defaultDatasetId"]).iterate_items(): print(item) # 📚 Want to learn more 📖? Go to → https://docs.apify.com/api/client/python/docs/quick-start ``` ## CLI example ```bash echo '{ "targets": [ { "name": "John Smith" }, { "npi": "1972902351" } ] }' | apify call malonestar/medicaid-exclusion-screener --silent --output-dataset ``` ## MCP server setup ```json { "mcpServers": { "apify": { "command": "npx", "args": [ "mcp-remote", "https://mcp.apify.com/?tools=malonestar/medicaid-exclusion-screener", "--header", "Authorization: Bearer " ] } } } ``` ## OpenAPI specification ```json { "openapi": "3.0.1", "info": { "title": "Medicaid Exclusion Screener — OIG LEIE + State Name/NPI Check", "description": "Screen names & NPIs against merged Medicaid/Medicare exclusion lists. Deduped OIG LEIE + state (NY OMIG) exclusions, name+NPI searchable, with a screen-verdict mode returning excluded yes/no, which list, and match confidence. Keyless. Screening/research tool, not compliance advice.", "version": "1.0", "x-build-id": "Ktl7oY9fXdFrWfI89" }, "servers": [ { "url": "https://api.apify.com/v2" } ], "paths": { "/acts/malonestar~medicaid-exclusion-screener/run-sync-get-dataset-items": { "post": { "operationId": "run-sync-get-dataset-items-malonestar-medicaid-exclusion-screener", "x-openai-isConsequential": false, "summary": "Executes an Actor, waits for its completion, and returns Actor's dataset items in response.", "tags": [ "Run Actor" ], "requestBody": { "required": true, "content": { "application/json": { "schema": { "$ref": "#/components/schemas/inputSchema" } } } }, "parameters": [ { "name": "token", "in": "query", "required": true, "schema": { "type": "string" }, "description": "Enter your Apify token here" } ], "responses": { "200": { "description": "OK" } } } }, "/acts/malonestar~medicaid-exclusion-screener/runs": { "post": { "operationId": "runs-sync-malonestar-medicaid-exclusion-screener", "x-openai-isConsequential": false, "summary": "Executes an Actor and returns information about the initiated run in response.", "tags": [ "Run Actor" ], "requestBody": { "required": true, "content": { "application/json": { "schema": { "$ref": "#/components/schemas/inputSchema" } } } }, "parameters": [ { "name": "token", "in": "query", "required": true, "schema": { "type": "string" }, "description": "Enter your Apify token here" } ], "responses": { "200": { "description": "OK", "content": { "application/json": { "schema": { "$ref": "#/components/schemas/runsResponseSchema" } } } } } } }, "/acts/malonestar~medicaid-exclusion-screener/run-sync": { "post": { "operationId": "run-sync-malonestar-medicaid-exclusion-screener", "x-openai-isConsequential": false, "summary": "Executes an Actor, waits for completion, and returns the OUTPUT from Key-value store in response.", "tags": [ "Run Actor" ], "requestBody": { "required": true, "content": { "application/json": { "schema": { "$ref": "#/components/schemas/inputSchema" } } } }, "parameters": [ { "name": "token", "in": "query", "required": true, "schema": { "type": "string" }, "description": "Enter your Apify token here" } ], "responses": { "200": { "description": "OK" } } } } }, "components": { "schemas": { "inputSchema": { "type": "object", "properties": { "mode": { "title": "Mode", "enum": [ "search", "screen" ], "type": "string", "description": "'search' browses/filters the merged exclusion list by name, NPI, or state. 'screen' takes a batch of targets and returns an excluded yes/no VERDICT per target (the compliance use case: check your providers/vendors against the lists).", "default": "search" }, "targets": { "title": "Targets to screen (screen mode)", "type": "array", "description": "screen mode ONLY. An array of people/entities to check, each an object with an optional 'name' and/or 'npi', e.g. [{\"name\":\"Jane Doe\",\"npi\":\"1234567890\"}, {\"npi\":\"1987654321\"}]. Each target yields one or more verdict rows: excluded true (with the matching list + confidence) or a single excluded:false row when nothing matches." }, "name": { "title": "Name filter (search mode)", "type": "string", "description": "search mode. Case-insensitive contains + fuzzy match against provider/business names and person names across the merged list. Empty = no name filter." }, "npi": { "title": "NPI filter (search mode)", "type": "string", "description": "search mode. Exact 10-digit National Provider Identifier to look up in the merged list. Empty = no NPI filter." }, "state": { "title": "State filter (search mode)", "type": "string", "description": "search mode. Two-letter US state code (e.g. NY, CA, TX) to keep only exclusions whose recorded state matches. Empty = all states." }, "lists": { "title": "Lists to load", "type": "array", "description": "Optional list keys to load, e.g. [\"OIG-LEIE\",\"NY-OMIG\"]. Empty = all enabled lists (currently OIG-LEIE + NY-OMIG). Scaffolded states (CA-MEDI-CAL, TX-OIG-HHSC) are disabled until their source URL/columns are confirmed at deploy.", "items": { "type": "string" } }, "fuzzyThreshold": { "title": "Fuzzy match threshold", "minimum": 0, "maximum": 1, "type": "number", "description": "Minimum name similarity (0-1) for a fuzzy-name match to count as a hit. 1 = exact only; lower catches more typos/variants at the cost of false positives. Default 0.85.", "default": 0.85 }, "maxResults": { "title": "Max results", "minimum": 1, "maximum": 200000, "type": "integer", "description": "Maximum number of records to emit. One record = one billable result.", "default": 5000 } } }, "runsResponseSchema": { "type": "object", "properties": { "data": { "type": "object", "properties": { "id": { "type": "string" }, "actId": { "type": "string" }, "userId": { "type": "string" }, "startedAt": { "type": "string", "format": "date-time", "example": "2025-01-08T00:00:00.000Z" }, "finishedAt": { "type": "string", "format": "date-time", "example": "2025-01-08T00:00:00.000Z" }, "status": { "type": "string", "example": "READY" }, "meta": { "type": "object", "properties": { "origin": { "type": "string", "example": "API" }, "userAgent": { "type": "string" } } }, "stats": { "type": "object", "properties": { "inputBodyLen": { "type": "integer", "example": 2000 }, "rebootCount": { "type": "integer", "example": 0 }, "restartCount": { "type": "integer", "example": 0 }, "resurrectCount": { "type": "integer", "example": 0 }, "computeUnits": { "type": "integer", "example": 0 } } }, "options": { "type": "object", "properties": { "build": { "type": "string", "example": "latest" }, "timeoutSecs": { "type": "integer", "example": 300 }, "memoryMbytes": { "type": "integer", "example": 1024 }, "diskMbytes": { "type": "integer", "example": 2048 } } }, "buildId": { "type": "string" }, "defaultKeyValueStoreId": { "type": "string" }, "defaultDatasetId": { "type": "string" }, "defaultRequestQueueId": { "type": "string" }, "buildNumber": { "type": "string", "example": "1.0.0" }, "containerUrl": { "type": "string" }, "usage": { "type": "object", "properties": { "ACTOR_COMPUTE_UNITS": { "type": "integer", "example": 0 }, "DATASET_READS": { "type": "integer", "example": 0 }, "DATASET_WRITES": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_READS": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_WRITES": { "type": "integer", "example": 1 }, "KEY_VALUE_STORE_LISTS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_READS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_WRITES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_INTERNAL_GBYTES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_EXTERNAL_GBYTES": { "type": "integer", "example": 0 }, "PROXY_RESIDENTIAL_TRANSFER_GBYTES": { "type": "integer", "example": 0 }, "PROXY_SERPS": { "type": "integer", "example": 0 } } }, "usageTotalUsd": { "type": "number", "example": 0.00005 }, "usageUsd": { "type": "object", "properties": { "ACTOR_COMPUTE_UNITS": { "type": "integer", "example": 0 }, "DATASET_READS": { "type": "integer", "example": 0 }, "DATASET_WRITES": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_READS": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_WRITES": { "type": "number", "example": 0.00005 }, "KEY_VALUE_STORE_LISTS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_READS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_WRITES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_INTERNAL_GBYTES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_EXTERNAL_GBYTES": { "type": "integer", "example": 0 }, "PROXY_RESIDENTIAL_TRANSFER_GBYTES": { "type": "integer", "example": 0 }, "PROXY_SERPS": { "type": "integer", "example": 0 } } } } } } } } } } ```