Sanctions and exclusion monitoring
Sanctions and exclusion monitoring is regularly checking providers against government lists of people and organizations barred from federal healthcare programs, such as the OIG's List of Excluded Individuals/Entities (LEIE) and SAM.gov, plus state licensing actions.
Why does it matter?
Federal healthcare programs generally won't pay for items or services furnished, ordered or prescribed by an excluded individual or entity. Plans and providers that use excluded providers can face penalties.
Which lists are checked?
Commonly the HHS Office of Inspector General's LEIE, exclusions in SAM.gov, state Medicaid exclusion lists, and actions by state licensing boards.
How is it different from directory accuracy?
Sanctions monitoring asks whether a provider is allowed to be paid. Directory accuracy asks where they practice and how to reach them. Most plans need both, often from different vendors.