Compliance & Credentialing
Cross-reference OIG exclusions, SAM.gov debarments, 50 state medical boards + DC, state Medicaid exclusion lists, federal court records, NPDB malpractice, FDA debarment, and Medicare billing, all from one query. Replace $50K+/year compliance tools with a from $199/month subscription.
How it works
This is a real screening report. Type a name or NPI, Medistill cross-references 130+ enforcement databases and returns a structured compliance dossier with risk scoring, billing analysis, and actionable recommendations.
Query
“How many doctors excluded from federal healthcare programs are still actively licensed in their state? Check across all states where we have medical board data and run a full compliance screen.”
LEIE Exclusions vs. Active State Licenses | 25 State Boards
Active licenses matched to LEIE exclusions
2,282
Total current LEIE exclusions
82,557
State boards with data (of 50 + DC)
25
LEIE exclusions with NPI
8,432
Top 10 States by Matches
Top Exclusion Types
| Code | Description | Count |
|---|---|---|
| 1128(b)(4) | License revocation/suspension | 33.0K |
| 1128(a)(1) | Program-related crime conviction | 25.5K |
| 1128(a)(2) | Patient abuse/neglect conviction | 8.0K |
| 1128(a)(3) | Felony healthcare fraud | 5.8K |
| 1128(a)(4) | Felony controlled substance | 3.5K |
| 1128(b)(14) | Default on health education loans | 2.2K |
| 1128(b)(8) | Entities controlled by excluded | 1.5K |
Top Excluded Specialties
| Specialty | Count |
|---|---|
| Nurse / nurses aide | 34.4K |
| Owner / operator | 3.2K |
| Personal care provider | 3.1K |
| Health care aide | 3.0K |
| Chiropractic | 2.0K |
| General practice / FP | 1.9K |
| Pharmacist | 1.7K |
| Home health agency | 1.4K |
| Dentist | 1.3K |
Follow-up query
“For the providers flagged in California, pull their Medicare billing history. Are any of them still billing Medicare despite being excluded?”
Excluded Providers with Confirmed Medicare Billing After Exclusion Date
Post-exclusion billing records found
16
Total Medicare paid post-exclusion
$1.09M
Total charges submitted
$3.32M
Patients seen post-exclusion
3,006
Post-Exclusion Billing Detail
| Provider | Specialty | City | Excl. Date | Excl. Type | Medicare Paid | Charges |
|---|---|---|---|---|---|---|
| Kowalski, David | Plastic Surgery | Beverly Hills | Apr 2023 | 1128(b)(7) | $106,343 | $523,063 |
| Kochumian, Minas | Internal Medicine | Northridge | Nov 2022 | 1128(a)(1) | $88,469 | $321,672 |
| Sreenivasan, Purnima | Geriatric Medicine | Walnut Creek | Dec 2016 | 1128(b)(4) | $222,461 | $524,691 |
| Olive Sleep & EEG Inc | IDTF (Diagnostic) | Burbank | Sep 2017 | 1128(b)(7) | $171,376 | $381,942 |
| Venkataraman, Raj | Psychiatry | Sacramento | Dec 2013 | 1128(b)(4) | $125,209 | $285,718 |
| Choi, Eddie | Physical Therapy | Los Angeles | Nov 2014 | 1128(a)(1) | $123,553 | $234,412 |
| Olsgard, Edward | Family Practice | Eureka | Dec 2016 | 1128(b)(4) | $44,963 | $112,174 |
| Uzun, Guven | Neurosurgery | Beverly Hills | Nov 2017 | 1128(b)(4) | $42,915 | $723,451 |
| Kim, Seonweon | Physical Therapy | Arcadia | Jun 2015 | 1128(a)(1) | $12,964 | $33,054 |
| Vyas, Jayshree | OB/GYN | Yorba Linda | Oct 2017 | 1128(b)(4) | $11,350 | $27,401 |
| Hill, Brent | Chiropractic | Modesto | Aug 2016 | 1128(b)(4) | $6,673 | $14,142 |
| Myint, Gerald | Internal Medicine | Hayward | Dec 2021 | 1128(a)(1) | $4,343 | $21,425 |
Compliance Screen Results
| Provider | Grade | Flags | Finding |
|---|---|---|---|
| Kowalski, David | F | OIG CMP | 15-yr exclusion + CMP for skin substitute fraud |
| Venkataraman, Raj | D | NPI deactivated | NPI deactivated Jul 2023, no reactivation |
| Kochumian, Minas | A | None | LEIE name match only; NPI-level clean |
| Sreenivasan, Purnima | A | None | LEIE name match only; NPI-level clean |
| Iqbal, Babar | A | None | LEIE name match only; NPI-level clean |
| Uzun, Guven | A | None | LEIE name match only; NPI-level clean |
Follow-up query
“Drill into David Kowalski. Pull his full compliance dossier, every enforcement action, billing history, and risk score.”
Plastic & Reconstructive Surgery · Beverly Hills, CA
NPI: 1558407413 · Enrolled: Jan 29, 2007
Active OIG Civil Monetary Penalty + 15-year federal exclusion. Kowalski agreed to be excluded for 15 years effective April 14, 2023 for causing fraudulent skin substitute billing at Tower Multi-Specialty Medical Group. Medicare data confirms $106,342 paid on his NPI in the same calendar year against 846 services and 103 patients. NPI remains active as of Jan 2026, no deactivation recorded.
Compliance flags, 130+ sources checked
OIG Civil Monetary Penalty (CMP), Active
David Kowalski, MD and Tower Multi-Specialty Medical Group agreed to be excluded for causing the submission of improperly billed claims for skin substitute products. Action date: April 14, 2023. Category: CMP and Affirmative Exclusions.
oig.hhs.gov/fraud/enforcement/joel-aronowitz-md...
OIG LEIE, Currently Excluded (1128b7) · Since Apr 14, 2023
Active exclusion from all federal healthcare programs under 42 U.S.C. §1128(b)(7) , fraud, kickbacks, or other financial misconduct. No reinstatement date on file. Any entity employing or billing through this NPI is subject to False Claims Act liability.
Post-exclusion Medicare billing confirmed
CMS Medicare utilization data (2023) shows $106,342.64 paid against NPI 1558407413 following the April 2023 exclusion date. 846 services across 103 beneficiaries in program year 2023. This constitutes ongoing illegal billing under federal exclusion rules.
71 other sources: no additional flags
SAM.gov debarment, FDA debarment, FDA CLIIL, CMS Medicare revocation, CMS Special Focus Facilities, NPI deactivation, CIA, state board discipline (CA), and 53 other databases returned no separate findings.
Provider identity, NPI registry
Full name
David Kowalski, MD
NPI
1558407413
Entity type
Individual (sole proprietor)
Specialty
Plastic & Reconstructive Surgery
License state
California
NPI status
Active (not deactivated) ⚠
Practice address
269 S Beverly Dr #367, Beverly Hills CA
Mailing phone
(310) 659-0705
Enumeration date
Jan 29, 2007
Medicare billing history (2013–2023), career summary
Total Medicare paid (career)
$7.64M
2013–2023
Total charges submitted
$38.8M
11-year total
Post-exclusion billing (2023)
$106,343
Confirmed illegal
Peak year billing
$1.67M
2019, skin substitutes
Dramatic billing spike 2018–2022 reflects the skin substitute fraud scheme , services jumped from ~3K/yr to 20K+/yr. 2023 billing ($106K) occurred entirely after the April 14 exclusion date.
Compliance verdict
Risk Grade F · 90/100
Medistill confirmed hits on two federal databases, OIG LEIE (active exclusion) and OIG CMP (Civil Monetary Penalty). The remaining 72 sources, including SAM.gov debarment, FDA debarment, CMS Medicare revocation, NPI deactivation, and 50 states + DC medical board datasets, returned no additional separate flags.
The fraud scheme in numbers: Between 2013–2017, Kowalski ran a normal-volume plastic surgery practice billing ~$250K/year. In 2018, services exploded from ~3,000/year to over 20,000, and charges went from $1.6M to $6.4–7.4M annually. The 2018–2022 period generated $6.4M in Medicare payments, over 84% of his entire career.
The active NPI problem: His NPI was last updated January 22, 2026, three years post-exclusion, with no deactivation recorded. Any practice, hospital, or health plan that credentialed him after April 14, 2023 without screening against LEIE is exposed under the False Claims Act.
What you can ask
Each question runs against real data. Follow-ups build on previous results , Medistill remembers context across the entire conversation.
Excluded providers still licensed
“How many doctors excluded from federal healthcare programs are still actively licensed in their state?”
Cross-references OIG exclusion list against 50 states + DC medical boards in one query, surfaces a patient safety gap no single tool can detect.
“For the ones in Florida, show their exclusion type, exclusion date, and what specialty they practice. Are any excluded for felony convictions?”
Narrows to a specific state and surfaces the most dangerous cases, felony exclusions with active licenses.
“Pull their Medicare billing history from the last available year. Are any of them still billing Medicare?”
Escalates from a licensing gap to potential active fraud, excluded providers billing Medicare is a False Claims Act violation.
Without Medistill
Manually cross-reference OIG LEIE download against each state board website. No single product does this automatically across all 50 states.
Single-provider risk score
“Run a compliance screen on NPI 1234567890. Check every federal exclusion list, state medical board, and enforcement database. Give me a risk score.”
One NPI, 130+ databases, scored 0–100 with a letter grade. The full credentialing check in a single question.
“The score shows a recency adjustment, explain why. Is this a current risk or a historical finding that’s been resolved?”
Distinguishes a 2024 exclusion from a 2008 reinstated one, the context that pass/fail tools miss entirely.
“Now pull their full profile, Medicare billing volume, top procedures, pharma payments, quality scores, and what state board says about their license.”
Turns a compliance check into a full credentialing dossier without switching tools.
Without Medistill
Run separate searches on OIG, SAM.gov, NPDB, and each state board. No risk scoring, results are pass/fail with no context.
Batch onboarding screen
“We just onboarded 15 new physicians. Screen all of them for compliance issues, OIG exclusions, SAM.gov debarments, state board discipline, FDA debarment, and NPI status.”
Screen your entire new roster at once. Flagged providers get risk grades and action recommendations, no per-provider fees.
“For the two that were flagged, show me exactly what was found, which databases triggered the flag, and whether the findings are current or historical.”
Immediately triages the batch, which flags need action now vs. which are resolved historical findings.
“One has a Grade C with a recency note. The other is Grade F with a current state board suspension. What’s the recommended action for each?”
Gets specific credentialing guidance, committee review vs. immediate hold, based on risk severity.
Without Medistill
Screen one provider at a time across 3–5 databases. Batch screening requires enterprise contract ($50K+/yr). No risk grading or action recommendations.
Facility risk cross-referencing
“Which nursing homes in Texas are on the CMS Special Focus Facility list AND have the highest penalty dollars AND the lowest star ratings?”
Joins three separate CMS datasets in one question, SFF list, penalty data, and star ratings, to find the highest-risk facilities.
“For the worst 5, show their ownership type, total Medicare payment, and whether the parent company has other facilities on the SFF list.”
Reveals whether a bad actor is a single facility or a parent company pattern, critical for network decisions.
Without Medistill
Download SFF list from CMS. Separately download penalty data. Separately pull star ratings. Join manually in Excel. No parent company cross-referencing available.
Discipline + pharma payment correlation
“Show me every physician in Ohio with an active state board disciplinary action who also received more than $25,000 in pharmaceutical payments last year. Are they still billing Medicare?”
Crosses state board discipline, Open Payments, and Medicare billing in one query, the kind of analysis that requires 4 separate subscriptions elsewhere.
“For each, what drugs are they prescribing the most in Part D? Is there a correlation between the payments they receive and the drugs they prescribe?”
Surfaces potential kickback patterns, disciplined providers prescribing products from companies paying them.
“Are any of these physicians listed as principal investigators on active clinical trials?”
A disciplined provider running clinical trials is a patient safety and regulatory red flag.
Without Medistill
Not possible in any single product. Requires separate subscriptions to state board data, Open Payments, Part D prescribing, and ClinicalTrials.gov, plus manual cross-referencing.
Hospital-wide compliance screen
“Screen every provider at Flushing Hospital Medical Center. Group the roster by specialty, Surgery, Internal Medicine, Cardiology, etc., and flag anyone with compliance issues.”
Facility lookup pulls the roster from our 273K-facility crosswalk, groups by specialty, then batch screens across 130+ sources, a full hospital compliance audit broken down by department in one query.
“For the flagged providers, are any of them also practicing at other hospitals nearby? I want to know if a compliance risk at Flushing is also a risk at surrounding facilities.”
Provider-facility crosswalk reveals multi-site practitioners, one flagged provider can be a risk at every facility they touch.
“We need to replace a flagged cardiologist. Find all cardiologists within 10 miles who are NOT at Flushing, screen them for compliance, and show their Medicare billing volume. I want clean, high-volume candidates.”
Geographic search + compliance screening + billing data turns a compliance problem into a recruitment pipeline in one conversation.
Without Medistill
Request a medical staff roster from the hospital, then manually screen each provider across multiple databases. Weeks of work for a single facility.
Predictive intelligence
Our machine learning model scores every US healthcare provider on future enforcement risk , trained on 7.1M providers, 130+ enforcement databases, Medicare billing patterns, prescribing data, and pharma payment records. Validated with walk-forward temporal backtesting.
7.1M
Providers scored
94.7%
Precision at score 60+
3x
Lift over random screening
4 years
Temporal backtest
Model trained on all data before year Y, then predicts which providers face enforcement in year Y. No data leakage.
| Prediction Year | Top 5% Catch Rate | Top 10% Catch Rate | Lift vs Random |
|---|---|---|---|
| 2021 | 14.7% | 32.1% | 3.2x |
| 2022 | 15.2% | 33.3% | 3.3x |
| 2023 | 16.3% | 31.9% | 3.2x |
What this means: Screening just the top 10% of risk scores catches ~32% of all providers who face enforcement action the following year, over 3x more effective than random screening. At higher scores the precision is even stronger: providers scoring 60+ have a 94.7% historical flag rate.
Production Score Distribution, Precision at Every Tier
Bars show historical flag rate at each score tier. Providers scoring 60+ are flagged 94.7% of the time.
Our predictive risk model scores 6,170+ hospitals on financial distress risk , trained on 7 years of Medicare cost reports with walk-forward temporal validation. Identify at-risk hospitals 12 months before distress becomes public.
See Hospital Risk Intelligence →Why switch
Beyond screening
No templates. No SQL. No engineering tickets. Just ask.
Turn any screening into a live, interactive dashboard, risk grades by department, flags by provider, exclusion trends over time. No SQL. No API. No templates.
Dashboard of our roster’s risk grades by department, with flags highlighted
One sentence generates a formatted compliance report, risk grade, database hits, billing analysis, recommendations. Attach it to the credentialing file.
Every screening, dashboard, and report is modifiable by asking. No forms. No re-running.
“Only show Grade D and F providers”
“Add the last 3 years of billing”
“Filter to Florida only”
“Exclude providers already terminated”
Schedule any screening to run daily, weekly, or monthly. Pull your roster from Google Sheets, screen against 130+ databases, deliver flagged providers on schedule.
Every Monday, screen our 200-provider roster from this Google Sheet and email me any new flags
Data coverage
Every screening cross-references federal exclusion lists, 50 state medical boards + DC, state Medicaid exclusion lists, federal court records, FDA enforcement actions, Medicare data, and malpractice records.
OIG LEIE, SAM.gov, NPDB malpractice, OIG integrity agreements, deactivated NPIs, OFAC SDN, DEA enforcement, TRICARE sanctions
Debarment list, disqualified investigators, warning letters, drug & device recalls
Revoked providers, Special Focus Facilities, nursing home penalties, Medicare opt-outs
License verification and disciplinary actions across all 50 state boards plus Medicaid exclusions
50 free credits, full access to all 130+ compliance databases across 50 states + DC, batch screening up to 1,000 providers, and risk scoring from day one. Cancel anytime.
from $199/month · Cancel anytime · No long-term contracts