ProviderScore Exclusion Screening

Description

Provider exclusion and sanction screening data, unioned from 6 distinct government source lists into a single table with a source_list discriminator column: OIG LEIE (federal healthcare-program exclusions), GSA SAM (federal procurement/contracting exclusions), FDA debarment (drug product application debarments), state medical/nursing/pharmacy board sanctions (13 states), state Medicaid program exclusions, and OFAC SDN (Treasury sanctions — not healthcare-specific, but a standard part of healthcare-vendor compliance screening). This is the same data underlying ProviderTrust/Streamline Verify-style compliance screening products. Columns not present in a given source's native schema are populated with an explicit typed NULL so the union is well-formed — see the per-source notes below for which columns are structurally absent (not just sparse) for each source_list.

  • Source: OIG (oig.hhs.gov), GSA SAM.gov, FDA, individual state medical/nursing/pharmacy boards, individual state Medicaid agencies, US Treasury OFAC.
  • Refresh cadence: varies by source — OIG LEIE refreshes monthly; GSA SAM, OFAC, and state lists refresh on their own publisher schedules.
  • Row count: 525,932. Per-table breakdowns are as of the 2026-07-15 measurement; headline row counts are current as of the export date.
  • Vintage: 2026-05-30, the maximum refresh indicator across the six sources at export time.
  • Coverage: see the per-source breakdown below; NPI coverage varies sharply by source and should not be relied on as a universal join key.

Per-source row counts and NPI coverage (2026-07-15 measurement)

source_list Rows Has NPI Has state Notes
oig_leie 83,256 8,608 (10%) 57 distinct values (all 50 states + territories) Federal exclusions from Medicare/Medicaid/all federal healthcare programs.
sam 168,715 43,457 (26%) 65 distinct values (states, territories, "XX" placeholder for unknown/foreign) Federal procurement exclusions — broader than healthcare; includes non-provider entities.
fda_debarment 149 0 (0%) 0 (never populated) Drug-application debarments; no state/NPI concept in the source.
state_board 174,403 17,254 (10%) 13 states only: CO, CT, DE, FL, IL, KY, MD, MO, NY, PA, TN, TX, WA Medical/nursing/pharmacy board disciplinary actions. Largest single source by row count but narrowest geographic coverage — do not imply 50-state coverage.
state_medicaid 82,810 12,113 (15%) 38 distinct states State Medicaid program exclusions, aggregated from each state's own downloadable list.
ofac_sdn 19,050 0 (0%) 0 (never populated) Treasury sanctions list; not healthcare-specific, included for standard vendor-compliance screening bundles.

Table: provider_exclusions

Snowflake: HEALTHPARSE_DATA.PROVIDER_EXCLUSIONS.PROVIDER_EXCLUSIONS

Column Type Description Notes
source_list VARCHAR Which of the 6 source lists this row came from: oig_leie, sam, fda_debarment, state_board, state_medicaid, ofac_sdn. Always filter/group on this before comparing rows across sources — the other columns' semantics shift per source (see table above).
entity_name VARCHAR The excluded/sanctioned individual or entity's name. For oig_leie, this is business_name if present, else `first_name
npi VARCHAR National Provider Identifier, when the source list carries one (or one was matched post-import). Structurally absent (always null) for fda_debarment and ofac_sdn. Populated for only 10–26% of rows in the 4 sources that carry it — see coverage table above.
state VARCHAR Two-letter state code (or similar) associated with the record, when the source has a state concept. Structurally absent for fda_debarment and ofac_sdn. sam includes non-standard values (territory codes, "XX" placeholder) beyond the 50 states.
exclusion_type VARCHAR The specific exclusion/sanction category, semantics vary entirely by source_list: OIG LEIE statutory authority code (e.g. 1128a1, 1128b5); SAM classification (e.g. "Ineligible (Proceedings Completed)"); FDA debarment status/term (e.g. "Permanent", "25 Year"); state board action type (e.g. "Dismissed", "revocation"); always medicaid_exclusion for state_medicaid; OFAC sanctions program (e.g. "CUBA"). Do not treat this as a single controlled vocabulary — it's 6 different source vocabularies passed through unchanged.
action_date DATE Date of the exclusion/debarment/sanction action. Sanity-guarded at export time: any raw value outside 1960-01-01–(today+1 day) is set to NULL rather than passed through (a known source artifact: one state_board_sanctions row carried 2909-07-03 in the live DB).
reinstatement_date DATE Date the individual/entity was reinstated (no longer excluded), when applicable. Same sanity guard as action_date. Null does not necessarily mean "still excluded" — it can also mean the source simply doesn't track reinstatement for that record type.
source_url VARCHAR Link to the specific state/agency source page or dataset this record came from. Structurally absent for oig_leie and sam (no per-record URL in those source formats) and for ofac_sdn.
_dataset / _vintage / _exported_at VARCHAR See README. —

Known limits

  • A small number of names carry encoding damage from the source file. Some federal lists publish accented characters in an encoding that was already mangled upstream, and we pass the name through as filed rather than guess at a repair. One row in this export is affected: the GSA SAM entry NAFTIRAN INTERTRADE CO. (NICO) Sÿ¿ÿ½rl, which should read "NAFTIRAN INTERTRADE CO. (NICO) Sarl". Match on the ASCII part of a name, not on an exact string, when screening non-US entity names.

Example queries (Snowflake)

-- 1. Screen a name against all 6 sources at once ("has this person/entity
--    ever appeared on any federal or state exclusion list").
SELECT "source_list", "entity_name", "state", "exclusion_type", "action_date", "reinstatement_date"
FROM HEALTHPARSE_DATA.PROVIDER_EXCLUSIONS.PROVIDER_EXCLUSIONS
WHERE "entity_name" ILIKE '%Smith, John%'
ORDER BY "action_date" DESC NULLS LAST;

-- 2. Currently-active OIG LEIE exclusions (no reinstatement on record) by NPI.
SELECT "entity_name", "npi", "state", "exclusion_type", "action_date"
FROM HEALTHPARSE_DATA.PROVIDER_EXCLUSIONS.PROVIDER_EXCLUSIONS
WHERE "source_list" = 'oig_leie'
  AND "npi" IS NOT NULL
  AND "reinstatement_date" IS NULL
ORDER BY "action_date" DESC;

-- 3. Counts by source and state, to scope a compliance program to the
--    states where state-board coverage actually exists.
SELECT "source_list", "state", count(*) AS n
FROM HEALTHPARSE_DATA.PROVIDER_EXCLUSIONS.PROVIDER_EXCLUSIONS
WHERE "source_list" = 'state_board'
GROUP BY "source_list", "state"
ORDER BY n DESC;