Burden Board
Where the paperwork is.
The more complex the paperwork, the more it costs. So we ranked the duties by how much paperwork they create — how often the check recurs, how many people it touches, how many files it reads — and we build in that order. Every figure is the source's, with the link and the date we read it.
Ranked by how much paperwork the rule creates: how often the check recurs × how many people or vendors it touches × how many files each check reads. Official figures are quoted as the source printed them on the read date, with the link. Where no official count exists we either did arithmetic from the rule's cadence and said so, or printed 'not read'. The ranking is our judgement about where the burden sits; it is not a statement about any organisation's compliance. Read 2026-10-02. Script-free copy.
The largest payers and health systems carry hundreds of thousands of employees and tens of thousands of vendors — every one of them on the monthly list.
The rules
Official figures, as read
- The LEIE is updated monthly; OIG recommends that providers screen employees and contractors monthly — HHS-OIG, Special Advisory Bulletin (2013) (official)
- Civil monetary penalty of up to $10,000 for each item or service furnished by an excluded person, plus an assessment of up to three times the amount claimed — HHS-OIG, Special Advisory Bulletin (2013) (official)
- 51 state and territorial Medicaid exclusion jurisdictions mapped; 15 read as files on this platform, the rest named as not read — Alpha Covenant Holdings, Known Limits (this platform)
Our arithmetic · An organisation with 50,000 employees and 5,000 vendors that screens monthly performs 660,000 LEIE look-ups a year, and the same again for SAM and for each state list it reads. Our arithmetic from the rule's cadence — not a published figure.
Why it ranks here · Highest recurrence (12× a year) × the largest population a rule touches (everyone on payroll, every vendor) × several files per look-up.
Build order · 1 — built: whole-roster batch with a monthly line-by-line diff; roster trial door at /roster · /roster
A state carries every enrolled provider, owner, agent and managing employee — the largest MCOs carry the same list again for their networks.
The rules
Official figures, as read
- Checks required upon enrollment and revalidation, and no less frequently than monthly for LEIE and SAM — 42 CFR 455.436(c) (official)
- Revalidation of all providers at least every 5 years — 42 CFR 455.414 (official)
Our arithmetic · A state with 150,000 enrolled providers performs 1.8 million monthly LEIE/SAM reads a year before counting owners, agents and managing employees. Our arithmetic — not a published figure.
Why it ranks here · Monthly cadence over an entire state's provider population, with identity confirmation on every row.
Build order · 2 — built: state-agency Duty Sheet, batch; door at /government · /government
Not legal advice, not a compliance assessment of anyone, not a measure of any organisation. The figures belong to the sources named; the arithmetic is ours and is labelled.