excluded_prescriber_payment_screen

Excluded Prescriber Payment Screen

What it answers

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

string · required

acknowledge_era_break

boolean · optional

default: false

op_lookback_years

integer · optional

default: 10

pdp_lookback_years

integer · optional

default: 10

Call it

From an agent: connect the Vlada MCP once (one click for Claude, ChatGPT, Cursor, VS Code) and ask in plain English; the agent selects excluded_prescriber_payment_screen when the question fits. From code: the same tool over REST with an API key. The schema endpoint needs no key.

curl -X POST https://api.vladahealth.com/v1/tools/excluded_prescriber_payment_screen \
  -H "Authorization: Bearer $VLADA_API_KEY" \
  -H "Content-Type: application/json" \
  -d '{"npi":"<npi>"}'

curl https://api.vladahealth.com/v1/tools/excluded_prescriber_payment_screen/schema      # the JSON schema, no auth
# MCP endpoint (Streamable HTTP): https://mcp.vladahealth.com/mcp

What comes back

Typed rows plus provenance on every answer: the public source file, its vintage, the methodology, and a response_hash you can replay. Prove and replay tools turn any number into a re-runnable receipt. A number the data cannot support comes back as “not in the data”, never as zero.

Sources behind it

drug_silver.dim_oig_leie
drug_silver.fact_drug_payment_to_prescriber
drug_silver.fact_part_d_prescriber

tables: drug_silver.dim_oig_leie · drug_silver.fact_drug_payment_to_prescriber · drug_silver.fact_part_d_prescriber

Known limits

open_payments_publication_lag_one_year
part_d_puf_annual_grain_only

As of the 2026-09-19 build of the served surface · machine-readable catalog · the live server may run a different version; the schema endpoint above is authoritative for what is deployed.