Mid-sized healthcare orgs manually screen thousands of providers and vendors against federal/state exclusion lists using spreadsheets, leading to dangerous gaps, false positives, and compliance risk.
A SaaS platform that ingests your provider/vendor roster, continuously monitors all relevant exclusion databases (OIG LEIE, SAM, state Medicaid lists), auto-resolves false positives using NPI and other identifiers, and provides a single compliance dashboard with audit-ready reporting.
Subscription tiered by number of entities screened (e.g., $500/mo for up to 1,000 entities, $1,200/mo for 5,000) with add-ons for state-level list coverage and API access for EHR/credentialing system integration.
This is a compliance obligation with real legal and financial consequences. Employing an excluded individual can result in CMPs of $100K+ per occurrence, treble damages, and program exclusion. The Reddit thread language ('ticking clock', 'stop trusting your own process', 'close calls') signals genuine fear and urgency. This isn't a nice-to-have — it's a must-have that's currently being done badly.
TAM estimate: ~15,000 mid-sized healthcare orgs in the US (outpatient networks, community hospital systems, managed care orgs) × ~$8,000 avg annual contract value = ~$120M addressable. Broader healthcare compliance TAM is $3B+. This is a solid niche — not massive, but enough for a very profitable SaaS business. Expansion into payers, pharma, and long-term care extends it further.
Compliance spend is non-discretionary. Orgs already employ full-time compliance staff ($70K-$120K/year) doing this manually. $500-$1,200/month is trivially justified vs. a single CMP ($100K+), vs. even one FTE's time. Budget exists in compliance departments. This is the rare B2B scenario where the ROI argument writes itself. The Reddit thread shows orgs are actively looking for solutions.
OIG LEIE and SAM.gov have downloadable data files and APIs. The core matching engine (name + NPI + DOB fuzzy matching with false positive scoring) is well-understood. State lists are the hard part — ~50 different formats, varying update frequencies, some only available as PDFs. A solo dev can build a working MVP covering federal lists + top 10 states in 6-8 weeks. Full 50-state coverage is a longer tail. The matching/deduplication logic needs to be solid but isn't novel.
Enterprise players (ProviderTrust, Verisys) serve large health systems at enterprise prices. The mid-market (500-5,000 entities) is stuck between expensive enterprise tools and DIY spreadsheets. No one owns the 'Stripe for exclusion screening' position — simple, self-serve, well-priced, modern UX, strong API. Streamline Verify is closest but lacks robust false positive resolution and state coverage. The gap is clear and validated by the Reddit thread.
This is inherently continuous monitoring — exclusion lists update monthly, providers/vendors change constantly, and compliance is ongoing. No one buys this once. Churn risk is very low because switching costs are high (audit trail history, integration setup) and the alternative is going back to spreadsheets. This is textbook sticky SaaS.
- +Regulatory tailwind — OIG enforcement is increasing, not decreasing, making this more urgent every year
- +Clear mid-market gap between enterprise tools ($5K+/mo) and DIY spreadsheets ($0 but dangerous)
- +Non-discretionary spend with obvious ROI ($500/mo vs. $100K+ CMP penalties)
- +Extremely sticky — continuous monitoring with audit trail history creates high switching costs
- +Pain signals are loud, specific, and from the exact target buyer persona
- +Well-defined, automatable problem with accessible data sources (OIG/SAM APIs)
- !State-level exclusion list ingestion is a long tail of scraping/parsing work across 50 states with varying formats — this is the unsexy moat but also the operational burden
- !Enterprise incumbents (ProviderTrust, Verisys) could move down-market with a self-serve tier if they see traction
- !Selling to healthcare compliance teams means long-ish sales cycles (1-3 months) and potential procurement/security review hurdles even at mid-market
- !Accuracy liability — a missed exclusion match could expose the platform to blame even if the org is ultimately responsible; need strong terms of service and E&O insurance
- !Market is niche enough that growth ceiling exists without expanding into adjacent compliance workflows (credentialing, licensure monitoring, sanctions screening)
Continuous automated exclusion monitoring against OIG LEIE, SAM, state Medicaid lists, and other sanctions databases. Offers identity resolution, workforce and vendor screening, and compliance dashboards with audit trails.
Cloud-based exclusion screening and monitoring service checking OIG, SAM, state exclusion lists, and FDA debarment lists. Focuses on simplicity and automation for healthcare compliance teams.
Part of a broader provider data management platform. Screens against OIG, SAM, state lists, and integrates with credentialing workflows. Owned by Verisys, a major provider data company.
Exclusion screening module within a broader healthcare compliance management suite. Checks OIG and SAM lists, provides basic monitoring and reporting capabilities.
Free federal databases
Web app where a compliance officer uploads a CSV of providers/vendors (name, NPI, DOB, state). System matches against OIG LEIE and SAM.gov databases nightly. Dashboard shows: clear, flagged (needs review), and confirmed matches. Auto-resolve obvious false positives using NPI match. Email digest alerts on new matches. Exportable audit report (PDF) showing screening date, source checked, result. Start with federal lists only + 5-10 highest-volume states. Skip API/EHR integration for MVP — CSV upload and manual export is fine for v1.
Free trial (screen up to 100 entities, federal lists only) → Starter at $500/mo (up to 1,000 entities, federal + top 10 states) → Pro at $1,200/mo (5,000 entities, all states, priority support) → Enterprise custom pricing (API access, EHR/credentialing integration, SSO, dedicated account manager). Add-on revenue from state-list expansion packs and API access. Upsell to adjacent compliance modules (licensure monitoring, sanctions screening) over time.
8-12 weeks to first paying customer. Weeks 1-6: build MVP (federal list matching, dashboard, CSV upload, basic alerts). Weeks 6-8: beta with 3-5 compliance officers from Reddit/LinkedIn outreach. Weeks 8-12: iterate on feedback, add top state lists, launch with $500/mo starter tier. Healthcare compliance buyers move faster than typical enterprise because the pain is acute and the risk is quantifiable.
- “compliance team is still doing a lot of exclusion screening manually”
- “once you are dealing with a few thousand providers + vendors things get messy fast”
- “We have had a couple close calls recently where someone slipped through longer than they should have”
- “different spreadsheets & different people responsible so no real system”
- “we have to clear 400 false positives because half the provider directory shares the same three last names”
- “Feels like a ticking clock sometimes”