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Excluded Prescriber Payment Screen

excluded_prescriber_payment_screen
Read-onlyIdempotent

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).

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
npiYes
op_lookback_yearsNo
pdp_lookback_yearsNo
acknowledge_era_breakNo

Output Schema

TableJSON Schema
NameRequiredDescriptionDefault
unitNo
as_ofNo
valueYes
sourceYes
statusNocomplete
caveatsNo
failureNo
qualityNo
refusalNo
vintageNoas_restated
audit_idYesUUID; ties to medicare_silver.audit_log row.
signatureNo
tenant_idNoCalling tenant slug, resolved by the binding and stamped via the per-call tenant context. Defaults to the bootstrap 'internal' tenant for local/in-process callers.
timestampYes
confidenceNo
data_as_ofNo
request_idYes
methodologyNo
snapshot_setYes{table_fqn → iceberg_snapshot_id (int64)}. Per M-2 §2.2.
tool_versionYes
response_hashYesSHA-256 of canonicalized form per M-2 §2.4.
result_statusYes
vintage_basisNodefault_unmeasured
as_of_assertedNo
as_of_observedNo
parse_revisionNo
as_of_effectiveNo
freshness_stateNounknown
methodology_eraNo
confidence_basisNo
semantic_versionYes
invariants_appliedNo
finality_confidenceNo
cms_vintage_sequenceYes
parser_artifact_hashYes
methodology_blend_factorsNo
parser_artifact_hash_basisNonot_evaluated

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