# OIG exclusions (LEIE)

URL: https://docs.healthcare.dev/datasets/oig-exclusions

<Freshness dataset="oig-exclusions" />

|                 |                                                                                                                                                                                    |
| --------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Source          | HHS Office of Inspector General ([LEIE downloads](https://oig.hhs.gov/exclusions/leie-database-supplement-downloads/)): the full database file and the monthly reinstatement files |
| Source id       | `hhs-oig-leie`                                                                                                                                                                     |
| Release cadence | Monthly (OIG replaces the file around the 10th with the previous month's actions)                                                                                                  |
| License         | Public domain (US government work)                                                                                                                                                 |
| Endpoints       | [`/v1/providers/{npi}/exclusions`](/reference/providers/oig-exclusions-recorded-with-an-npi), [`/v1/exclusions?q=&state=`](/reference/providers/search-oig-exclusions-by-name)     |
| MCP tool        | `check_provider_exclusion`                                                                                                                                                         |
| Plans           | Every plan, Free included (a lookup or a search per call)                                                                                                                          |

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`.

```sh
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"
```

```json
{
  "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 answer

- **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](https://exclusions.oig.hhs.gov), 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)

Most records list no NPI. The [joined provider answer](/joined-answers#possible-exclusion-matches)
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](/datasets/medicare-ownership#possible-exclusion-matches).

## What is never stored

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.