OIG Exclusion13d ago
NPI: 1922348218
| LEIE row ID | 7 |
| Type | 1128a1 |
| Exclusion date | 2018-04-19 |
| Description | OTHER BUSINESS |
| Dataset release | 2026-05-08 |
Source: OIG LEIE Exclusions List
The Fonteum graph defines four deterministic risk rules. One is active today — OIG exclusion screening against the OIG LEIE file. Two more are defined and dormant: anomalous payment patterns and NPPES-vs-PECOS specialty mismatches activate once their source data is keyed into the graph. Claim inactivity is planned, pending a claims dataset. Each signal cites the exact source row — not an ML confidence score, a primary-source fact.
Each rule is a pure function of federal data rows. Rule a checks the OIG LEIE exclusion file (active today). Rule b compares Open Payments totals against specialty-level percentiles. Rule c cross-joins NPPES and PECOS taxonomy columns. Rule e checks claim activity windows. No model, no threshold tuning.
Every signal carries a structured evidence JSON that cites the specific source row(s) that triggered it: LEIE row ID, Open Payments total, or PECOS specialty. You can independently verify any signal by looking up the cited record directly in the federal source.
Signals are recomputed nightly via an Inngest cron. Each recomputation is idempotent — the same source data always produces the same signal. If the source data changes (e.g. an exclusion is removed), the signal resolves automatically and resolved_at is set.
Most recent signals across the provider graph, ordered by severity then recency.
A provider NPI matched a record in the OIG LEIE monthly exclusion file. Excluded providers are barred from receiving payments from federal health programs. The signal cites the LEIE row ID, exclusion type, and exclusion date.
Active: Live today against the OIG LEIE exclusion file.
Source: OIG LEIE — oig.hhs.gov/exclusionsA provider's total CMS Open Payments amount for a given year exceeds the 95th percentile for their specialty. Elevated payment totals may indicate financial relationships with device or pharmaceutical manufacturers worth scrutiny in network contracting.
Dormant: Defined and ready; activates when CMS Open Payments is keyed to NPI in the graph.
Source: CMS Open Payments — openpaymentsdata.cms.govRisk signals are available via the provider NPI API at /api/risk/[npi]. Each response carries full 14-tuple provenance linking the signal to its source row.
The primary taxonomy code in NPPES does not match the specialty registered in CMS PECOS. NPPES is self-reported; PECOS is validated at enrollment. A mismatch can indicate a stale NPPES record or an administrative discrepancy that may affect network directory accuracy.
Dormant: Defined and ready; activates when a PECOS taxonomy/specialty column lands to compare against NPPES.
Source: NPPES vs. CMS PECOS cross-checkA provider with an active NPI and enrollment status has no claims activity in the most recent 12-month window. This signal will activate once the claims dataset is integrated. It is currently a stub rule that will fire against CMS Part B claims data.
Planned: Planned; fires once a CMS Part B claims dataset is integrated.
Source: CMS Part B Claims (pending integration)