If you advance money against medical claims, the borrower isn't the only party you're underwriting. A payer decides which claims clear. If a provider on the account has been excluded from Medicare or Medicaid, those claims can stop paying, and your collateral goes with them.
That's why an OIG exclusion check belongs in every healthcare file. The trouble is that the OIG list is only one of several. A full screen also covers federal sanctions, federal debarment, state Medicaid exclusions and the national provider registry. Each one has its own website, its own search box and its own way of showing a match.
ROX now runs all five in a single search, inside the underwriting file. We call it Healthcare Search.
What a healthcare exclusion screening has to cover
Healthcare Search checks a medical business or a person against five official government sources:
- OFAC (U.S. Treasury). The federal sanctions list, including known aliases. This result shows first on every search, as "Exact match" or "No exact match".
- LEIE (HHS Office of Inspector General). The OIG exclusion list of providers barred from billing Medicare and Medicaid. This is the list most people mean when they talk about an OIG exclusion check or a LEIE search.
- SAM.gov. Businesses and people barred from federal contracts. A SAM exclusion check catches debarments that won't appear on the OIG list.
- State Medicaid exclusion lists. About 40 states plus DC. A provider can be excluded by one state's Medicaid program and still be absent from the federal list.
- NPI Registry (NPPES). Confirms the provider is real and returns their NPI number and specialty.
Run those one at a time and a single application can mean dozens of lookups, plus screenshots to prove you did them.
One row per person, so nobody gets skipped
A healthcare application rarely has one name on it. There's the business, its owners and every provider who bills under it. Healthcare Search gives each of them their own row. You can check them one by one, or use bulk search to run everyone you select in one click.
Providers the applicant enters in the client portal are picked up automatically. Your team doesn't retype names from a PDF, and a provider added late in the process still gets screened.
Clear statuses and a record of every decision
Every result comes back with one of four statuses: Sanctioned, Excluded, Needs review or Clear.
Name matches are messy, and a common name will often hit someone else's record. When that happens, the underwriter can save a real match to the file or mark the person as cleared with a note explaining why. Either way the decision is documented, which is what an auditor or credit committee will ask to see later.
The results sit next to the rest of the file, so they flow into the same credit memo as your bank data, financials and KYB checks.
Built on official government sources
Healthcare Search pulls from free, official government lists, and it needs no separate provider agreement, so you can screen healthcare deals without adding another data contract. If you already use LexisNexis through ROX for background and watchlist checks, the two work side by side in the same third-party data hub.
Keep screening after you fund
An exclusion can land months after a clean onboarding check. You can turn Healthcare Search on as a monitoring source, so the business, its owners and its providers stay in your post-funding monitoring next to the rest of your data. Healthcare Search is available on every ROX plan, including the three free applications.
Who it's for
Healthcare Search was built for companies that fund against healthcare receivables:
- Medical receivables factoring companies and healthcare factors
- Lenders and MCA funders with provider clients
- Clearinghouses and revenue-cycle platforms that are adding funding to their product
It fits into the healthcare underwriting workflow ROX already runs: collect documents, verify the organization, decide on one file, then monitor the account after funding. You can see the full workflow on the ROX healthcare page.
FAQ
What is the OIG exclusion list? It's the List of Excluded Individuals and Entities (LEIE), kept by the HHS Office of Inspector General. It names providers and businesses barred from billing Medicare and Medicaid.
Is an OIG exclusion check enough on its own? For a funder, usually not. The LEIE doesn't include state Medicaid exclusions, SAM.gov debarments or OFAC sanctions. Healthcare Search checks all of them, plus the NPI Registry, in one search.
How often should you check the OIG exclusion list? Check at onboarding for the business, its owners and every provider. A clean result is a snapshot of one day. Turn Healthcare Search on as a monitoring source to keep screening the account after funding, and run a new search whenever providers are added.
Does Healthcare Search replace manual review? No. It does the lookups and flags possible matches. Your underwriter still decides whether a match is real, and ROX keeps a record of that decision.
How much does a search cost? One credit per name, and that one credit covers all five sources. Screening a business, its two owners and three providers is six credits. There is no separate subscription or add-on fee, and it works on every ROX plan.
Try it on your next healthcare deal
ROX gives you three free applications with no credit card required. Get started free or book a demo and we'll run Healthcare Search on a live file with you.