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Check Provider Exclusion

check_provider_exclusion
Read-onlyIdempotent

Is this healthcare provider barred from Medicare, Medicaid and other federal health programs? Screens a person or business name — or an NPI — against the HHS OIG List of Excluded Individuals/Entities, the list you are required to check before paying, employing or contracting with a provider. Answers "is Dr X excluded", "check this provider against the OIG exclusion list", "has this practice been barred from Medicare", and pre-payment or credentialing screening. Returns matching exclusions with the date of birth, state, city, specialty and NPI that tell same-named people apart, plus when the exclusion started and the statutory reason for it, and a match_confidence saying what was actually matched. Never returns a bare yes/no: several excluded people can share a name, so identifying the right one is the caller's job and this gives them what they need to do it. Pass npi to turn a name lead into an identification. Sourced from HHS OIG.

Input Schema

NameRequiredDescriptionDefault
npiNoThe provider's 10-digit NPI, if you have it. An NPI match is an identification rather than a name lead — always pass it when known.
nameNoProvider or business name to screen, e.g. "John Smith" or "Acme Home Health". Any order; surname-first works too.
limitNoMaximum candidates to return (default 10, max 50).
stateNoTwo-letter state code to narrow candidates, e.g. "CA". Useful when a common name returns several people.

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A4.3/5.0
Behavior5/5

Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?

The description goes well beyond the annotations by detailing exactly what is returned (DOB, state, city, specialty, NPI, exclusion start, statutory reason, match_confidence), and by warning that it never returns a bare yes/no because multiple excluded people can share a name. This gives the agent important behavioral context that annotations alone do not provide.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness4/5

Is the description appropriately sized, front-loaded, and free of redundancy?

The description is dense but organized and front-loaded with the core screening purpose. Every sentence adds relevant detail, resulting in a comprehensive yet efficient explanation. It could be slightly tighter, but it earns its length given the tool's nuanced output behavior.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness5/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

With no output schema, the description fully explains the return value composition, including distinguishing fields and match_confidence. It also covers source, use cases, parameters, and the crucial caveat about shared names and identification. An agent has enough information to call the tool correctly without needing additional structured data.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters4/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

Schema coverage is 100%, so the baseline is 3, but the description adds real meaning: it clarifies that npi turns a name lead into an identification, explains that state narrows candidates for common names, and notes the name field accepts any order. This is useful enrichment beyond the schema's field-level descriptions.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose4/5

Does the description clearly state what the tool does and how it differs from similar tools?

The description clearly states the tool screens a person or business name or NPI against the HHS OIG List of Excluded Individuals/Entities, and gives concrete example questions. It is specific and unambiguous, but it does not explicitly differentiate itself from the sibling tool provider_exclusion_coverage, so it misses the 'distinguishes from siblings' bar for a 5.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines4/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

The description gives clear use cases such as pre-payment or credentialing screening and answers like 'is Dr X excluded'. It also explains when to pass an NPI. However, it never mentions when not to use this tool or names an alternative, so it falls short of explicit when-not guidance.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.

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