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Exclusion & Sanction Checks

Updated

The article explains checking if a healthcare professional is barred from federal or state programs by searching government exclusion and sanction lists. It details three API methods—Search Exclusions and AdverseCheck Essentials —with varying source coverage. Results include matched identities, exclusion records, sanctions, and specialty certificates, each with detailed fields for verification.

 

Three ways to check

All three return the same kind of result — they differ in how you search and which sources they cover.

Check Endpoint Sources searched
Search Exclusions /v1/identity/search OIG, SAM, State Medicaid
AdverseCheck Essentials /v1/adversecheck/essentials OIG, SAM, State Medicaid
AdverseCheck Pro /v1/adversecheck/pro OIG, SAM, State Medicaid, OFAC, Medicare Opt Out
The acronyms: 
OIG — Office of Inspector General · SAM — System for Award Management · OFAC — Office of Foreign Asset Control.  Pro adds OFAC and Medicare Opt Out for the broadest coverage.
 

Search Exclusions

An identity-based search — match on as many details as you have. Only name is required.

Field Required What it is
name Yes The professional’s name.
license No The professional’s license number.
npi No 10-digit National Provider Identifier.
address No Address lines 1 and 2 (e.g. 123 S Central St, Apt 18).
city No City of residence.
state No State of residence.
zipCode No ZIP code (e.g. 01125).
dob No Date of birth, YYYYMMDD. Partial dates allowed (e.g. 1962 or 196205).
For your technical team:
POST https://api.propelus.com/v1/identity/search
{
  "name": "Jordan Rivera",
  "license": "RN1234567",
  "npi": "1234567890",
  "address": "123 S Central St, Apt 18",
  "city": "Denver",
  "state": "CO",
  "zipCode": "01125",
  "dob": "19820522"
}

 

AdverseCheck (Essentials & Pro)

Both share the same request shape — Pro simply searches more sources.  Provide aliases and licenses to widen the match.

Field Required What it is
name Yes The professional’s name.
names[] No Name plus aliases. If provided, the single name is ignored. Each entry has a name.
license[] No One or more licenses. Each: number (required), professionCode, stateCode (two-letter).
dob No Date of birth, YYYYMMDD (partial allowed). Coming soon.
For your technical team
{
  "name": "Jordan Rivera",
  "names": [
    { "name": "Jordan Rivera" },
    { "name": "J. Rivera" }
  ],
  "license": [
    { "number": "RN1234567", "professionCode": "RN", "stateCode": "CO" }
  ],
  "dob": "19990121"
}

 

What comes back

Every check returns a code and a list of matched identities. found means at least one match; not_found means none.

Field What it tells you
code found or not_found.
items[] The matched identities.
npi NPI of the matched professional.
score Match confidence score.
names[] Name parts: first, middle, last, prefix, suffix, fullName.
phones[] Phone numbers on the record.
exclusions[] The exclusion / sanction records found — one entry per match. Detailed below.

 

Inside each exclusion record

Every entry in exclusions[] describes a single match against one of the source lists. At minimum each carries a name object — the same name parts used elsewhere in the response — identifying who the sanctioning body listed.

Field What it tells you
first First name as it appears on the source list.
middle Middle name or initial, if the list carries one.
last Last name as listed.
prefix Name prefix (e.g. Dr.), if present.
suffix Name suffix (e.g. Jr., III), if present.
fullName The full name as a single string.

Alongside the name, each record carries the exclusion itself — who issued it, why, and when — plus an address object for the listed person.

Field What it tells you
excludingAgency The body that issued the exclusion (e.g. the OIG or a state Medicaid agency).
exclusionsType The kind of exclusion or the reason for it.
excludedDate When the exclusion took effect.
reinstatementDate When the person was reinstated, if they have been.
licenseNumber A license tied to the exclusion, where the list provides one.
profession The profession recorded on the exclusion.
affiliation An affiliated entity or organization.
dateOfBirth Date of birth on the record.
additionalComments Free-text notes from the source list.
listCode Which source list the record came from.
address Object: address, city, state, zipCode.
Fields vary by source
Lists publish different detail, so which fields are populated depends on where the match came from. Some sources also carry extra fields such as reportType, reference, cageCode, or amendment, and structured sanction records (e.g. board orders and actions) and specialty-certificate details. Confirm against the originating list before acting. 
{
  "code": "found",
  "items": [
    {
      "professional": {
        "npi": "1234567890",
        "score": 87,
        "names": [
          { "first": "Jordan", "last": "Rivera", "fullName": "Jordan M Rivera" }
        ],
        "phones": [ {} ],
        "attributes": {
          "exclusions": [
            {
              "name": { "first": "Jordan", "last": "Rivera", "fullName": "Jordan M Rivera" },
              "address": { "city": "Denver", "state": "CO", "zipCode": "80202" },
              "excludingAgency": "OIG",
              "exclusionsType": "1128(a)(1)",
              "excludedDate": "2021-03-18",
              "reinstatementDate": null,
              "profession": "RN",
              "listCode": "LEIE"
            }
          ]
        }
      }
    }
  ]
}
About score
Each match carries a confidence score. Review higher-scoring matches first, and confirm against the exclusion details before acting.
 

Sanctions & Specialty Certificates

Besides exclusions[], a match’s attributes can carry two other kinds of structured record. Each is tagged with a type so you know how to read it.

Sanctions

Disciplinary sanctions gathered from multiple sources. The type identifies the source format — for example sanction::fsmb for Federation of State Medical Boards data. A sanction groups one or more orders, and each order groups one or more actions.

Field What it tells you
type The source format, e.g. sanction::fsmb.
entity The body that issued the sanction (e.g. Department of Health and Human Services).
orders[] The disciplinary orders. Each has a date, effectiveDate, code, and description.
actions[] The actions under an order. Each has a code, description, effectiveDate, expirationDate, and a basis object (code + description). 
{
  "type": "sanction::fsmb",
  "entity": "Department of Health and Human Services",
  "orders": [
    {
      "date": "2025-07-18",
      "effectiveDate": "2025-08-01",
      "code": "OP",
      "description": "Other prejudicial action",
      "actions": [
        {
          "code": "A0244",
          "description": "License suspension",
          "effectiveDate": "2025-08-01",
          "expirationDate": "2026-08-01",
          "basis": { "code": "B0049", "description": "Unprofessional conduct" }
        }
      ]
    }
  ]
}

 

Specialty Certificates

Board specialty certifications, tagged type: "specialtyCertificate". The detail object describes the certificate and its current standing; recertifications[] lists the renewal history.

Field What it tells you
type specialtyCertificate.
certificateName & certificateType The certificate and its type.
memberBoardName The certifying member board (with memberBoardId).
mocPathwayName Maintenance-of-certification pathway, if any (with mocPathwayId).
currentDurationType How the certificate’s current term is measured (e.g. time-limited).
initialCertification The first certification: startDate, endDate, durationType, reverificationDate.
recertifications[] Each renewal: startDate, endDate, durationType, reverificationDate. 
{
  "type": "specialtyCertificate",
  "detail": {
    "certificateId": 100234,
    "certificateName": "Internal Medicine",
    "certificateType": "General",
    "memberBoardId": 12,
    "memberBoardName": "American Board of Internal Medicine",
    "mocPathwayId": null,
    "mocPathwayName": null,
    "currentDurationType": "Time-limited",
    "initialCertification": {
      "startDate": "2007-07-01",
      "endDate": "2017-02-28",
      "durationType": "TL",
      "reverificationDate": "2016-12-01"
    }
  },
  "recertifications": [
    {
      "durationType": "TL",
      "startDate": "2025-03-01",
      "endDate": "2035-03-01",
      "reverificationDate": "2034-12-01"
    }
  ]
}
Which records appear depends on the source
Not every match carries sanctions or specialty certificates — they show up only when a source provides them. Always branch on the type field rather than assuming a fixed shape.

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