OIG exclusions (LEIE)

Each record is one exclusion: the individual's or business's name, the NPI and UPIN as OIG lists them, OIG's general category and specialty, the address OIG lists, the exclusion type (1128a1) with its statutory authority in words and whether it is mandatory or permissive, the exclusion date, and the reinstatement date and waiver when there is one. status: active means the current file lists the exclusion (it is in effect); a reinstated exclusion stays available with status: retired and its reinstatement_date.

curl https://api.healthcare.dev/v1/providers/1922348218/exclusions \
  -H "Authorization: Bearer $HDEV_API_KEY"

curl "https://api.healthcare.dev/v1/exclusions?q=dunn%20medical&state=MS" \
  -H "Authorization: Bearer $HDEV_API_KEY"

{
  "data": {
    "npi": "1922348218",
    "exclusion_recorded": true,
    "matched_by": "npi_as_listed",
    "note": "Matched by NPI as listed in the OIG file (LEIE). Most LEIE records carry no NPI, so an empty answer means no exclusion recorded with this NPI, not that the provider is not excluded: ...",
    "exclusions": [
      {
        "id": "oig-8dc1acf9a8f90e51",
        "npi": "1922348218",
        "name": { "display": "184TH STREET PHARMACY CORP" },
        "exclusion_type": "1128a1",
        "exclusion_authority": "1128(a)(1): conviction of program-related crimes",
        "exclusion_category": "mandatory",
        "exclusion_date": "2018-04-19",
        "reinstatement_date": null,
        "status": "active"
      }
    ]
  }
}

How to read an answerCopy Anchor Link

• Matched by NPI as listed in the OIG file. /v1/providers/{npi}/exclusions returns the exclusions whose NPI field in OIG's file is that NPI. Only about one LEIE record in ten has an NPI, so exclusion_recorded: false means no exclusion recorded with this NPI, never "not excluded". Every answer carries a note that says so; show it with the result.
• Search by name (/v1/exclusions?q=) for the rest, optionally by state and entity_type. A name match is not an identity match: meta.note says so.
• Confirm identity with OIG. OIG asks that any match be verified through its online search, which checks the SSN or EIN. Matching exclusions to NPIs by name and address is a separate, derived feature (not this dataset).
• Lifted exclusions come from OIG's monthly reinstatement files (the last 12 to 21 months OIG keeps online); an exclusion that leaves the file without one stays with status: retired, reinstatement_date: null. Add include_reinstated=true to search them.

Possible matches by name (Pro and up)Copy Anchor Link

Most records list no NPI. The joined provider answer adds exclusion_matches: records without an NPI that may belong to the provider, matched by rules on name and state with middle name, address and specialty as further evidence, each with its confidence and derivation. They are possible matches, never a finding of exclusion; see how they are made.

What is never storedCopy Anchor Link

The public file has no SSNs or EINs (the Privacy Act forbids OIG to publish SSNs), and we would never store one if a column appeared. Dates of birth are in OIG's file but are never read. This is data about providers, not patients: no PHI.

id is ours (OIG publishes none): a hash of the name, NPI, UPIN, exclusion type and date and state, plus the address for businesses (OIG lists a business once per location). A business whose address OIG corrects gets a new id.