FACIS, Medicaid, and VA Contracts: The Caregiver Screening Rules Every Home Care Agency Needs to Know
If your home care agency bills Medicaid or holds a contract with the Department of Veterans Affairs (VA), you are mandated to do specialized exclusion screening. It is the difference between getting paid and owing the federal government a very large fine. The rules also change depending on the program. What keeps you compliant for Medicaid will not always keep you compliant for the VA, and the reverse is true too.
This guide explains what FACIS is, why exclusion screening is required by law, and how the rules differ for Medicaid contracts versus VA contracts. The goal is to help your agency stay covered on both.
What is FACIS?
FACIS stands for Fraud and Abuse Control Information System. It is the healthcare industry’s leading database for exclusion and sanction screening. FACIS pulls data from thousands of sources and puts it in one place so you can check whether a person or company has been barred from working in federally funded healthcare.
The data inside FACIS covers several areas. It includes federal exclusions from the HHS Office of Inspector General (OIG), SAM.gov, the GSA, the DEA, and the FDA. It includes state exclusions, such as the Medicaid exclusion lists kept by the 44 states that maintain them. It also includes license disciplinary actions like suspensions, revocations, and restrictions across every state and provider type. Finally, it includes early warning data, such as licensing board meeting minutes, that can point to a problem before any formal action is taken.
A regular background check looks at a person one time. FACIS is built to keep watching. Most agencies screen their workers when they are hired and then check continuously with monthly monitoring so they catch new exclusion as soon as they appear. FACIS is sold in tiers that build on each other. The two that matter most for home care agencies are Level 1 and Level 3. Level 1 includes all federal exclusion sources plus the state Medicaid exclusion lists, and it is the lowest tier that still meets compliance rules for organizations that receive federal healthcare dollars. Level 3 includes everything, with all states, all license disciplinary actions, early warning data, and historical records. Agencies that want the strongest and most defensible program tend to choose Level 3.
Why exclusion screening is required by law
The rule starts with the Social Security Act. When the OIG excludes a person or a company, no federal healthcare program will pay for any service they provide, order, or prescribe. This is true whether the payment is direct or passes through another party first.
Three ideas drive the requirement. The first is reciprocity, which means that being excluded from one federal program excludes you from all of them. Because of this, checking only the OIG list is not enough to stay compliant. You have to check several federal databases plus the state lists. The second idea is timing. Since 2013, the government has expected monthly screening. A yearly check is no longer enough. The OIG list should be checked every month so you do not keep an excluded person on your team. The third idea is reach. The rule applies to far more than nurses and other licensed staff. It also covers aides, drivers, schedulers, volunteers, owners, managers, and contractors. Anyone whose work touches a service the government pays for is included.
The penalties are serious. Fines can reach up to $10,000 for each service an excluded person provides, plus damages of up to three times the amount claimed. If the violations form a pattern, your agency can lose the ability to receive federal funding at all.
Exclusion screening for Medicaid contracts
If your agency serves Medicaid clients or clients who qualify for both Medicare and Medicaid, federal and state rules require you to screen against three databases.
Required databases for a Medicaid contract:
- OIG LEIE, the federal List of Excluded Individuals and Entities
- SAM.gov, the federal System for Award Management, which covers government-wide debarment and sanctions
- Your state’s Medicaid exclusion list – FACIS III
The state list matters because it often contains people who never show up on the federal databases, and that data can take a long time to move from the state level up to the federal level. Leaving it out is one of the most common compliance gaps.
You also need to screen on the right schedule and across the right people. Plan to re-screen everyone every 30 days, since monthly monitoring is the accepted Medicaid standard and accrediting groups such as NCQA reinforce it. Screen all of your covered staff, not only the licensed clinicians. When you find a match, act quickly. Many state Medicaid programs require you to report an exclusion within 30 days, remove that person from any paid work right away, and pay back any claims you already submitted for their services.
For a Medicaid home care agency, this usually means FACIS Level 1M or higher, monitored every month.
Exclusion screening for VA contracts
Here is where many agencies get confused. VA health care is a separate program, funded by the federal government on its own terms. The OIG exclusion rules still apply, though, because the VA counts as a federal healthcare program. On top of that, the VA adds its own requirements.
The most important point is that the VA bars anyone on the OIG list or on SAM.gov from joining its provider network. Both lists are required.
Required databases for a VA contract:
- OIG LEIE
- SAM.gov
- These would both be covered in the nationwide criminal search with Sure Check.
Medicaid vs. VA at a glance
| Medicaid contract | VA contract | |
|---|---|---|
| Program type | State and federal healthcare program | Federal healthcare program |
| Required databases | OIG LEIE, SAM.gov, and your state’s Medicaid exclusion list | OIG LEIE and SAM.gov (add your state’s Medicaid list if caregivers also serve Medicaid clients) |
| Who credentials you | State Medicaid agency | CCN uses the VA’s administrator; VCA uses RLDatix/Verge |
| Screening schedule | Every 30 days | Every 30 days |
| Who must be screened | All covered staff and contractors | All covered staff and contractors, with flow-down required |
| Penalty exposure | Fines up to $10K per service, treble damages, loss of funding | Same federal exposure plus removal from the VA network |
| Minimum FACIS tier | Level 1M | Federal sources with SAM.gov, or Level 1M if also serving Medicaid |
How Sure Check keeps your agency compliant
Exclusion screening is the kind of ongoing task that quietly builds up risk until an audit or a clawback turns it into an emergency. Sure Check builds continuous exclusion monitoring into your screening program so your agency stays covered across both Medicaid and VA requirements. We screen the right federal and state sources, on the right schedule, for every covered person, and we keep the records that prove you did it.
Whether you serve Medicaid clients, plan to pursue a VA contract, or both, we build your screening around the specific program you are billing so it actually fits.
If you are ready to close the gaps in your exclusion screening, reach out to Sure Check Background Screening at surecheckbackground.com or maggie@surecheckbackground.com.
This article is for general information and is not legal advice. Exclusion screening requirements vary by program, state, and contract. Please talk with your compliance counsel for guidance that fits your agency.