In healthcare, exclusion monitoring isn’t just a regulatory requirement— it’s one of the strongest defenses against fraud, waste, and abuse.

In theory, the process is simple: Healthcare organizations must monitor the individuals and entities they work with against federal and state exclusion lists to ensure that they’re eligible to receive Medicare and/or Medicaid funds.

However, once you dig into the step-by-step processes involved, effective exclusion monitoring becomes much more complex. This guide will take you through exclusion monitoring at a high level, giving you the tools to begin mapping out processes for your organization.