# excluded_prescriber_payment_screen

Excluded Prescriber Payment Screen · v1.2.0 · drug

Given an NPI (10-digit), returns OIG LEIE exclusion status and — if excluded — any Open Payments received OR Part D prescribing activity recorded AFTER the exclusion date (and before any reinstatement). The textbook qui-tam / False Claims Act screening query. Bridges three substrate sources: dim_oig_leie (LEIE), fact_drug_payment_to_prescriber (Open Payments), fact_part_d_prescriber (Part D Prescriber-by-Drug).

Returns: total post-exclusion payment dollars + Part D drug-cost exposure, broken down by year + top 5 manufacturers. Every answer carries an explicit exclusion_status (not_in_leie, excluded, or excluded_then_reinstated) beside the dollars, so a $0 result is never ambiguous: a not-in-LEIE NPI returns zero ANCHORED to the LEIE snapshot date it was checked against (leie_asserted_at), which is a different thing from an excluded prescriber who drew no post-exclusion payments.

KNOWN GAPS: open_payments_publication_lag_one_year (current PY publishes June+1); part_d_puf_annual_grain_only (Part D PUF is annual not monthly — finer-grain timing requires claims data). LEIE refreshes monthly per the M-6 schedule (cycle 2).

**Inputs.**
- `npi` (required): 
- `op_lookback_years`: 
- `pdp_lookback_years`: 
- `acknowledge_era_break`: 

**Known limits.**
- open_payments_publication_lag_one_year
- part_d_puf_annual_grain_only

**A real answer** (customer seat, 4.88 s, args `{"npi":"1447200742"}`):

```json
{
 "value": {
  "headline": 0.0,
  "npi": "1447200742",
  "npi_query": "1447200742",
  "is_excluded": false,
  "exclusion_status": "not_in_leie",
  "leie_asserted_at": "2026-11-04",
  "exclusion_record": null,
  "post_exclusion_payments_total_usd": 0.0,
  "post_exclusion_payments_count": 0,
  "post_exclusion_pdp_total_drug_cost_usd": 0.0,
  "post_exclusion_pdp_total_claims": 0,
  "payments_by_year": [],
  "top_manufacturers": [],
  "zero_basis": "no LEIE exclusion for this NPI, so no post-exclusion window exists to measure payments or prescribing in. The zero is by construction, not an empty read."
 },
 "unit": "USD",
 "result_status": "answered",
 "methodology_era": {
  "era_name": "leie_monthly_refresh_post_2026_05_16",
  "era_start": "2026-05-16",
  "era_end": "2099-12-31"
 },
 "methodology_blend_factors": null,
 "source": {
  "source_url": "medicare://excluded_prescriber_payment_screen"
 },
 "vintage": "as_restated",
 "cms_vintage_sequence": 1,
 "parse_revision": 1,
 "as_of_observed": null,
 "as_of_asserted": null,
 "as_of_effective": null,
 "caveats": [],
 "confidence": null,
 "finality_confidence": null,
 "response_hash": "9a47b7708ff85a59ab1811fe59bfb05d00f26855a2386855b1a24c87b86c0525",
 "semantic_version": 1,
 "tool_version": "1.2.0",
 "parser_artifact_hash": "0b11193fb97519397f53ffe2917938b1bf95f408fccb5bae6d356b17ef22a148",
 "parser_artifact_hash_basis": "tool_source_sha256",
 "signature": null,
 "tenant_id": "probe-customer-canary",
 "status": "complete",
 "audit_id": "c6207f25-b076-429f-94bc-ea5be4ea24d6",
 "timestamp": "2026-11-09T21:37:51.340868Z",
 "request_id": "7c67bcbf-05bb-4c4f-bc2b-6f7266e60af2",
 "audience": "customer",
 "answer": {
  "value": 0.0,
  "value_ref": "value",
  "unit": "USD",
  "scope": {
   "tool": "excluded_prescriber_payment_screen",
   "filters": {
    "npi": "1447200742"
   }
  }
 },
 "method": "Read from the CMS publication. The published values are reported as published, with no adjustment or modelling applied.",
 "evidence": {
  "response_hash": "9a47b7708ff85a59ab1811fe59bfb05d00f26855a2386855b1a24c87b86c0525",
  "audit_id": "c6207f25-b076-429f-94bc-ea5be4ea24d6",
  "request_id": "7c67bcbf-05bb-4c4f-bc2b-6f7266e60af2"
 }
}
```

REST: `POST https://api.vladahealth.com/v1/tools/excluded_prescriber_payment_screen` with the inputs as the JSON body. MCP: the tool by name.