Exclusion screening for home health & hospice

One excluded attendant, hundreds of Medicaid-billed visits

Consider what the Chinese-American Planning Council Home Attendant Program in New York City had to resolve in June 2023. The OIG alleged that the program kept a personal assistant on its roster after that worker had been excluded from New York Medicaid, then billed Medicaid for the care the assistant continued to deliver in patients' homes under the state's Consumer Directed Personal Assistance Program. The settlement came to $866,339.25. No clinical error sat behind it, no quality complaint, no fraudulent intent the OIG needed to prove. The worker was simply on a list, the agency did not catch it, and every billed visit became a violation.

That pattern repeats across home-based care because of where the work happens. A home health aide arrives at a private residence alone, performs the visit, and leaves. There is no charge nurse glancing at the schedule, no credentialing desk in the lobby, no second set of eyes on who actually walked through the door. When the person furnishing care turns out to be excluded, the gap can run for months of dated, billable encounters before a payer audit surfaces it. The dollar figures track that exposure: Serenity Home Healthcare Services in Ohio paid $146,952 over a single excluded home health aide, and AccuCare Home Health Services in Mesa, Arizona settled for $20,000 in September 2025 over the same fact pattern, again an aide.

Why 2026 turned up the heat on home-based care

Two federal moves reshaped the risk picture for this segment, and both point at the same blind spot. First, CMS now publishes ownership data for all 11,000-plus Medicare-certified home health agencies and 6,000-plus hospices, naming direct and indirect owners and tracking ownership changes back to 2016. Regulators and journalists can finally follow an excluded or sanctioned individual across the agencies they control. Second, in May 2026 CMS opened a six-month nationwide moratorium on new home health and hospice enrollments, paired with site visits, revocations, and heightened screening in high-risk states including Arizona, California, Georgia, Nevada, Ohio, and Texas.

The message from both actions is that home-based care is being treated as a fraud-prone category, and that ownership is now squarely in scope. Screening the bedside roster is no longer the whole job. An excluded owner, director, or managing employee sitting behind the agency is exactly the kind of relationship the new transparency is built to expose.

What a single missed aide actually costs

An OIG exclusion carries a flat consequence: no federal health program will pay for any item or service furnished by an excluded person, whether the work is billed directly or folded into a bundled claim. For an agency whose revenue is almost entirely Medicare and Medicaid, one excluded aide running a normal visit schedule can contaminate a wide band of claims. Under 42 CFR 1003.210, the numbers compound:

• Up to $20,000 per item or service furnished by the excluded individual, and an aide can rack up hundreds of separately billable visits in a single quarter.
• An assessment of up to three times the amount claimed on top of the penalty.
• Overpayment refunds on everything the excluded person touched, with False Claims Act liability layered on if the conduct continued.

One detail trips up agencies more than any other: federal and state exclusion are separate. The CAPCHAP case turned on a New York Medicaid exclusion, not the federal LEIE. A worker reinstated federally can still sit on a state sanction list, and a Medicaid-funded home health or hospice roster has to be clean against both. Most screening tools sell all-state Medicaid coverage as a paid add-on. Provider Signals includes every state list on every plan, free tier included.

The people who show up in the home, all of them

Home-based staffing is fluid by design. Aides and per-visit clinicians cycle in and out, branches share float pools, and the workers logging the most patient hours are frequently the lowest-credentialed and highest-turnover roles. The LEIE refreshes monthly, so a roster that screened clean at hire drifts out of date within weeks. Provider Signals is shaped around how this workforce really moves:

• Aides and personal-care workers, not just licensed staff. Every home health settlement above involved an aide or attendant, never a physician. They belong on the roster next to RNs, therapists, and social workers.
• Per-visit and 1099 contractors. Contract nurses, PRN therapists, on-call clinicians, and hospice chaplains all furnish billed services, so liability follows them regardless of W-2 status.
• Owners, directors, and managing employees. Now that CMS publishes agency ownership, the people behind the business need screening as much as the people at the bedside.
• Continuous re-checks. New hires clear on day one and the full roster re-screens on every refresh, so an intake-day clean record never quietly turns into a finding mid-episode.
• Audit-ready proof. A dated, exportable log of every screen stands up to surveyors, payers, UPIC and ZPIC reviewers, and your own compliance file.

Where the legacy screening vendors fall short

Incumbent exclusion-screening platforms are priced for hospital systems, commonly $15,000 to $200,000 a year, and many still meter state Medicaid coverage as an upgrade. On home health and hospice margins, that pricing simply does not pencil out for an independent or regional operator. Provider Signals runs the same continuous, all-source monitoring as a self-serve product, sized to the roster you actually staff.

OIG guidance points to screening at hire and again every month, tracking the monthly LEIE refresh. Running that cadence by hand across a churning roster is where agencies slip; Provider Signals re-checks continuously so nothing waits for the next manual pass. See how it works on the exclusion screening overview, compare other segments on the industry hub, or size your roster on the pricing page.

How we match your roster

Exclusion screening is only as good as its matching. We match each person or entity against every source using the full identifier set together — NPI, first name, last or organization name, city, state, and ZIP — never one field alone. NPI alone misses records (the OIG LEIE and many lists don’t carry an NPI for every entry); a name or a location alone produces false matches on common names. When a source record has no NPI, we fall back to name plus location.

Because accuracy depends on your input, provide complete, correct details for every roster entry. When more than one possible match is found, we show you all candidates with their source records so you can confirm, select, or merge — we never auto-flag anyone as excluded. Always verify a match against the primary source before taking any action.

Frequently asked questions