Understanding your results
VerifiedCare profiles are built from federal government data — not self-reported. Here is what every badge, rating, and term on a profile means.
ID What is NPI verification?
An NPI (National Provider Identifier) is a 10-digit number assigned by the federal government (CMS / NPPES) to every healthcare provider. If a caregiver has an NPI, they are registered in the federal system.
This does not mean they are currently licensed or in good standing — it means they exist in the federal registry. Always confirm a current state license before hiring.
⚠ What is the OIG Exclusion List?
The Office of Inspector General (OIG) maintains a list of providers excluded from participating in federal healthcare programs (Medicare, Medicaid). Being on this list is serious — it typically means fraud, patient abuse, or a felony conviction.
VerifiedCare checks every provider against this list daily. A red ⚠ OIG EXCLUDED badge means do not hire this person for any federally funded care.
# What is a CCN?
A CCN (CMS Certification Number) is a federal ID assigned to nursing homes and facilities certified to participate in Medicare / Medicaid. Only facilities that have passed a CMS inspection get a CCN.
Facilities with a CCN have 1–5 star ratings published by the federal government, shown directly on their VerifiedCare profile.
★ What do the CMS star ratings mean?
CMS rates certified facilities from 1 (much below average) to 5 (much above average) stars across four measures:
Overall rating — a combined summary score.
Health inspections — results of on-site state inspections of safety and care quality.
Quality measures — how residents actually fare (e.g. falls, infections, mobility).
Staffing — nursing hours per resident per day. Higher staffing generally means better care.
M What does “Medicare active” mean?
The provider is currently enrolled in Medicare and authorized to order and refer services. It is a positive signal of active federal participation. The absence of Medicare activity is neutral — not every caregiver bills Medicare.
⚠ What does “Special Focus Facility” mean?
A Special Focus Facility (SFF) is a CMS designation for facilities with a history of persistent, serious quality problems. This is a major red flag and warrants extra scrutiny before placing a loved one there.
★ Trust tiers explained
| Tier | What it means |
|---|---|
| Tier 1 — Federally rated | NPI-verified, OIG clear, and matched to a CMS-certified facility (CCN) with published 1–5 star inspection ratings. The strongest signal. |
| Tier 2 — Medicare active | NPI-verified and OIG clear, with active Medicare enrollment (authorized to order & refer). |
| Tier 3 — Registry verified | NPI-verified and OIG clear, with no Medicare or CCN record on file. Neutral — common for individual caregivers. |
| Tier 4 — Flagged | OIG-excluded or Medicare-revoked. Do not hire for federally funded care. |
? Frequently asked questions
- Is this person currently employed?
- The NPI registry shows federal registration, not current employment or availability. Always confirm directly with the caregiver or agency.
- Does an NPI mean the caregiver is licensed?
- No. An NPI is federal registration and is separate from state licensure. Verify a current license with your state licensing board.
- What should I check before hiring?
- 1) OIG status must be clear (no red badge). 2) Verify a current state license. 3) Ask for and call references. 4) For facilities, review the CMS star ratings and any Special Focus designation.