What one source misses, measured against the record.
Fonteum is a US healthcare provenance registry that publishes signed, chain-of-custody-attested research and data pages on Medicare, Medicaid, and federal regulator datasets, drawing from 44 federal source families across CMS, OIG, HRSA, AHRQ, and HHS.
The public alternatives — a raw NPPES download, federal -only screening, a single state list — each cover one slice of the provider record. Federal-only screening misses of state Medicaid bars, and no single exclusion list names more than of barred providers. Every number below is lifted from a published study and links back to it.
Last updated: June 2026 · Sources: published Fonteum research on the OIG LEIE, CMS PECOS, SAM.gov, and ten state Medicaid exclusion lists
What each screening approach catches
No single public list names every barred provider. Across the OIG LEIE, SAM.gov, and ten state Medicaid programs, NPI-identified providers are excluded; the most complete single source covers 64.0%. The rows below describe coverage by approach, not by vendor.
full coverage partial gap
| Screening approach | What it catches | What it misses | Field-level provenance |
|---|---|---|---|
| Raw NPPES download | Provider identity only — NPPES carries no exclusion or sanction field | All barred providers — exclusion status is not in the file | File modified date only; no per-field source or limitation |
| Federal OIG LEIE only | of NPI-identified barred providers (64.0%) | (36.0%) — including of state Medicaid bars | Raw federal file; not cited field-by-field |
| Single state exclusion list | One state's bars — e.g. New York names providers absent from the federal list | Every other state and the federal layer; of bars sit on one layer only | One source, one format; no cross-source reconciliation |
| Fonteum provenanced graph | Excluded-anywhere across OIG LEIE + SAM.gov + ten state Medicaid lists, joined on NPI | Records with no NPI are reported separately, not silently dropped | Source name, snapshot date, SHA-256, and limitation on every field |
Counts from the excluded-provider landscape study and the federal–state exclusion gap study. A coverage match is a screening flag for a primary-source look, not a Fonteum judgement of any provider.
Four findings a single source cannot produce
of state Medicaid bars are invisible to federal screening
Of NPI-identified providers excluded across ten state Medicaid programs, carry no record on the federal . An employer checking the federal list alone clears nearly two in three state-barred providers as having nothing on file.
is the most any single exclusion list covers
Across the OIG LEIE, SAM.gov, and ten state Medicaid programs, NPI-identified providers are barred from a public health program — yet the single most complete list names only of them. appear on only one of the three layers, so no two-list check reaches them.
barred providers still hold an active Medicare enrollment
Cross-referencing the OIG exclusion list against surfaces 19 of 6,880 in-force federal exclusions that still carry an active enrollment record — two standing over a year, one excluded since 2015. The join is the finding; a single list cannot produce it.
order/refer-eligible providers carry an active exclusion
Of providers cleared to order and refer in Medicare, 170 match an active exclusion or sanction across the OIG, SAM.gov, and the ten-state ring — 156 on a state list, 18 on the federal LEIE, 6 on SAM.gov. A match is a flag for a primary-source look, not a proven claim.
Raw NPPES vs the provenanced graph
The NPPES registry is the starting point — active providers, refreshed weekly. It is identity, not the rest of the federal record. Fonteum re-ingests the same file and joins it to the sources NPPES does not carry.
| Capability | Raw NPPES download | Fonteum provenanced graph |
|---|---|---|
| Provider identity (NPI, taxonomy) | Yes — the NPPES file is the registry | Same NPPES file, re-ingested on its weekly cadence |
| Medicare enrollment status | Not in NPPES | CMS PECOS, joined on NPI |
| Federal exclusion flag | Not in NPPES | OIG LEIE, joined on NPI |
| Multi-source exclusion / compromise | Not in NPPES | SAM.gov, ten state Medicaid lists, CMS CMPs, OIG integrity agreements |
| Facility quality, staffing, deficiencies | Not in NPPES | CMS Care Compare, PBJ staffing, NH deficiency citations |
| Per-field provenance | None — a flat file of values | 14-tuple chain: source, date, hash, methodology version |
| Freshness tracking | Whole-file timestamp | Per-field snapshot date on each source's native cadence |
Every joined field carries its source name, snapshot date, and known limitation via the . See the field-level provenance pipeline.
Three dimensions a single download cannot match
Breadth
Fonteum draws on 44 federal source families — CMS, OIG, HRSA, and more — joined on NPI and CMS Certification Number. A coverage question like "is this provider barred anywhere" only has an honest answer when the OIG LEIE, SAM.gov, and ten state Medicaid lists are reconciled against one another, because 55.6% of barred providers sit on a single layer.
Freshness
Each source is re-ingested on its own native cadence — NPPES weekly, OIG LEIE monthly, Care Compare and staffing quarterly — and every snapshot is tagged with a retrieved date, a SHA-256 hash of the source file, and a methodology version. A static download shows one whole-file timestamp; the graph shows when each field was last reconciled.
Provenance
Every rendered fact ties to a source name, a snapshot date, and any known limitation, attested to a 14-tuple chain. That is the difference between a number you can cite to a federal record on a given date and a derived score you have to take on trust — the distinction that matters most for compliance and diligence.
Coverage, honestly
- What does federal OIG LEIE-only exclusion screening miss?
- Federal OIG LEIE-only screening misses of state Medicaid bars: of NPI-identified providers excluded across ten state Medicaid programs, carry no record on the federal list. Measured against every barred provider — across the OIG LEIE, SAM.gov, and ten state lists — the federal list names of , so checking it alone clears (36.0%) barred providers as having nothing on file. The gap is the cross-source population a single federal list cannot see.
- How is raw NPPES different from the Fonteum provider graph?
- Raw NPPES is a weekly flat file of provider identity — NPI, name, taxonomy, address — with no exclusion field, no Medicare enrollment status, no facility quality, and no per-field provenance. The Fonteum graph re-ingests that same NPPES file on its weekly cadence and joins it on NPI and CMS Certification Number to PECOS enrollment, OIG LEIE exclusions, SAM.gov and ten state Medicaid lists, and CMS Care Compare quality records — each rendered field carrying its source name, snapshot date, SHA-256, and any limitation. NPPES answers who a provider is; the graph answers what else the federal record says about them.
- Is there a single list that catches every excluded provider?
- No single list catches every excluded provider. Across the OIG LEIE, SAM.gov, and ten state Medicaid programs, NPI-identified providers are barred, and the most complete single source — the OIG LEIE — names only 64.0% of them. of barred providers appear on only one of the three layers, so even a two-list check leaves a population uncovered. Coverage comes from reconciling the sources against one another on a shared identifier, which is what the compromised-anywhere layer does.
- What does compromised-anywhere coverage add beyond exclusion lists?
- Compromised-anywhere coverage adds the layer between fully clean and formally excluded. Beyond the barred providers, CMS civil money penalties across facilities and 127 active OIG corporate integrity agreements describe providers sanctioned or under a compliance obligation but still operating. These records carry no NPI to match, so Fonteum reports them as a separate compromised-but-operating layer rather than forcing a false join — surfacing the signal without overstating the match.
- Are these coverage numbers independently checkable?
- Yes. Every figure on this page is lifted from a published Fonteum research study and links back to it, and each study cites the federal datasets it joins — OIG LEIE, CMS PECOS, SAM.gov, the state Medicaid lists — with snapshot dates. The underlying sources are federal public works, so anyone can pull the same files and reproduce the join. Fonteum attests each rendered field to a 14-tuple provenance chain rather than asking readers to take a derived verdict on trust.
- Does broader coverage mean Fonteum rates or flags providers itself?
- No. Fonteum does not rate, inspect, endorse, or independently judge any provider. A coverage match means a named federal or state source lists that provider on a given date — the page reports the source record and its date, not a Fonteum verdict. Each match is a screening flag worth a primary-source look, not a proven claim about the provider, and matches are made on NPI, never on name alone, to avoid conflating distinct people.
- The excluded-provider landscape → Why no single list names more than 64.0% of barred providers.
- The federal–state exclusion gap → The 64.3% of state Medicaid bars federal screening cannot see.
- Coverage network map → The distribution surfaces that consume the Fonteum graph.
- Source library → 44 federal source families with tier, refresh cadence, and limitations.
- Field-level provenance → How every fact ties to a federal record on a date.