West Virginia Provider Exclusions and Terminations List
The West Virginia Provider Exclusions and Terminations List contains providers excluded from participating in West Virginia Medicaid.
With HealthProviders DB, you can search the OIG-LEIE, SAM, CMS, FDA, NPI, and all state Medicaid exclusion lists at once—for FREE!
To date, the Health and Human Services Office of Inspector General (HHS-OIG), the System for Award Management (SAM), and all State Medicaid Agencies have reported more than 320,000 exclusions combined. Save yourself a lot of time and effort—Upload your provider list, and we will deliver you a complete, consolidated Exclusion Report in minutes!
West Virginia Exclusion Screening Requirements
Providers participating in or applying to the West Virginia Medicaid program must screen employees and contractors before hiring against the West Virginia Provider Exclusions and Terminations List maintained by the West Virginia Department of Health Bureau of Medical Services, the Health and Human Services (HHS) Federal Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE), and the System for Award Management (SAM), to ensure they have not been excluded from participation in the program, and again monthly to ensure they have not been excluded from participation in the program since the last search.
The West Virginia Bureau for Medical Services Provider Manual Chapter 800.5.5.1 Provider Screening—Providers must review publicly available databases at least monthly to identify any individuals/entities that have been disqualified or excluded via criminal conviction/license revocation or restricted from providing/being reimbursed for services paid by any federal/state program.
Providers excluded by the Office of Inspector General (OIG), terminated by any State Medicaid Agency, or debarred from receiving federal contracts, grants, or financial assistance cannot participate in federally funded healthcare programs. This includes Medicare, Medicaid, TRICARE, and the Children’s Health Insurance Program (CHIP). Additionally, the Centers for Medicare & Medicaid Services (CMS) can revoke billing privileges, prohibiting the provider from participating in Medicare.
Providers are liable for overpayments made for any items or services provided by any excluded person for which the provider received reimbursement from federal healthcare programs. Additionally, the provider may face Civil Monetary Penalties (CMP) if it fails to ensure proper exclusion screening.
Do You Need a One-Time Exclusion Screening?
One-time Exclusion Screening is a healthcare compliance batch exclusion screening service that compares your list of healthcare providers against the OIG LEIE, SAM, CMS, NPI, FDA, and State Medicaid exclusion lists, delivering a consolidated & comprehensive downloadable exclusion screening report—starting at just $25 for up to 100 providers screened.
One-time Exclusions Screening is useful for new provider onboarding, credentialing, vendor screening, or periodic compliance checks. It’s ideal for small organizations with a limited number of providers that want to verify exclusions and gather documented evidence themselves.
One-time Exclusions Screening is used for:
- New provider onboarding
- A compliance review
- An internal audit
- Credentialing
- Enrollment
- Vendor screening
- Contracting
- Periodic compliance checks
- A specific provider population
Do You Need Continuous Exclusion Monitoring?
Continuous Exclusion Monitoring automatically checks your monitored provider list against updated exclusion data as new source data becomes available and notifies you when a provider’s exclusion status changes.
Continuous Exclusion Monitoring Features include:
- Easily manage your list of all healthcare providers, employees, vendors, and contractors for continual exclusion monitoring.
- Automatic monthly updates imported from OIG, SAM, and State Medicaid Exclusion Lists and matched to your provider list.
- Automatic Exclusions Change Notifications.
- Comprehensive, always-current, and audit-ready Exclusions Report available for download anytime.
- Exclusions Dashboard with total Providers, Exclusions, Verifications, Reinstatements, Medicare Opt-out, and NPI deactivations.
- Built-in Exclusion Primary Source Verification Tools.
- Save Notes & Documented Evidence of Exclusion Screening.
One-time Screening vs Continuous Exclusion Monitoring
| One-Time Screening | Continuous Monitoring | |
|---|---|---|
| Best for | Occasional screening | Ongoing compliance |
| Provider list | Upload when needed | Continuously maintained |
| OIG LEIE | ✓ | ✓ |
| SAM | ✓ | ✓ |
| State Medicaid | ✓ | ✓ |
| Recurring monitoring | — | ✓ |
| Automatic change alerts | — | ✓ |
| Monitoring dashboard | — | ✓ |
| Saved screening evidence | — | ✓ |
| Price | $25/100 providers | $89 Monthly subscription |
What Databases Are Checked?
HealthProviders DB is a national healthcare provider database with over 9 million profiles—updated daily directly from publicly available state and federal databases—including the complete NPI database & deactivated numbers list, OIG LEIE, SAM, CMS Revoked Medicare Providers & Medicare Opt-out, all State Medicaid Sanctions, Suspensions, Terminations, and Exclusion lists, plus state license active status, and state licensing board disciplinary actions, FDA debarments, and Clinical Investigator Disqualifications.
| Database | What it identifies |
|---|---|
| OIG LEIE | Individuals and entities excluded from federal healthcare programs |
| SAM.gov | Federal exclusions and debarments |
| State Medicaid | State-specific Medicaid exclusions, terminations, and sanctions |
| State Licenses | State-specific licensing and disciplinary actions |
| CMS | Medicare opt-outs and revoked providers |
| FDA | FDA debarments and clinical investigator disqualifications |
| NPI | NPI deactivation status |
Frequently Asked Questions
Who should be included in Exclusion Screening?
Healthcare organizations must screen all individuals and entities that provide items or services payable by federal health care programs. This requirement applies to anyone whose work supports services reimbursed by Medicare or Medicaid—whether those services are provided directly or indirectly.
Healthcare Providers & Facilities
Hospitals, nursing homes, home health agencies, clinics, and physician practices.
Personnel
All employees (clinical and non-clinical), pharmacists, pharmacy staff, physicians, nurses, clinical staff, medical assistants, and administrative staff.
Contractors & Vendors
Third-party billing & coding services, transportation providers, ambulance services, and medical equipment suppliers.
Leadership & Support
Board members, managers, owners, and volunteers.
Basically, if an individual’s role contributes in any way to federally reimbursable services, that individual should be included in your OIG exclusion screening and Medicare exclusion monitoring process.
What happens when an exclusion for the provider is found?
You should verify and document all matches, as evidence of provider screening, for audit review. Pay special attention to potential matches by name only and verify against other identifying information such as NPI, name, address, and license information. You can find detailed provider information in the HealthProviders DB provider profile. The Exclusions Report includes a link to the provider’s profile.
Verify the exclusion with the primary-source government record and document the findings. Confirm whether the exclusion matches the primary-source record or is a false positive; either way, document your findings. HealthProviders DB includes a link to the primary-source exclusion record for each match in the Exclusion Report to help with verification.
The HealthProviders DB Continuous Exclusions Monitoring subscription lets you save exclusion screening verification notes and documents with the provider exclusion, and they are included with the Exclusions Report for audit review.
You should review the Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs for additional guidance. If you find a confirmed exclusion match for an already employed individual or contractor, you should review the Self-Disclosure Protocol to help minimize any potential CMP.
Organizations should follow their compliance procedures and applicable requirements.
Can a name match be a false positive?
Yes. A name match alone does not necessarily mean that a provider is excluded. Review potential matches using additional identifying information such as NPI, name, address, and license information, and verify them against the applicable primary-source record.
Can I monitor employees and contractors?
Yes. You can use continuous monitoring for employees, contractors, and other individuals or entities your organization has determined should be included in its exclusion-screening process.
Can I monitor vendors?
Yes. Organizations can include vendors and other business relationships when those parties fall within the organization’s screening requirements. The appropriate scope depends on the organization’s programs, contracts, payer requirements, and applicable laws and regulations.
Can I verify an exclusion against the original government source?
Yes. HealthProviders DB provides links to applicable primary-source records so you can investigate potential matches and verify them against the underlying government source before your organization takes action.
Can I document what I did after reviewing a potential exclusion?
Yes. HealthProviders DB lets you save screening notes and documented verification evidence with the provider exclusion, and these are included in the exclusion report, helping your organization maintain a record of its screening and verification activity.
What information is included in the Exclusions Report?
The Exclusions Report includes provider name and address, NPI and deactivation information, license information, Medicare opt-out information, exclusion dates and reasons, reinstatement information, match status, and links to primary-source records for verification.
Can I start with one-time screening and switch to continuous monitoring?
Yes. A one-time screening can establish an initial baseline for a provider population. If your organization then needs ongoing monitoring, it can use the provider list for continuous exclusion monitoring to identify subsequent changes.
Does continuous monitoring replace my organization’s compliance program?
No. Continuous exclusion monitoring is a screening and monitoring tool. It does not replace your organization’s compliance policies, legal obligations, credentialing procedures, or professional judgment. Organizations should determine which individuals and entities need screening and what actions are required when they identify a potential exclusion or other status change.
What if I need help?
We are here to help you. Contact us with any questions and support you need. We can help you upload your provider list and show you how to use the verification tools to verify exclusions and document your screening evidence.
Resources
Code of Federal Regulations (CFRs) applicable to Program Integrity (not an all-inclusive list):
- 42 CFR 438 – Managed Care
- 42 CFR 455 – Program Integrity: Medicaid
- 42 CFR 456 – Utilization Control
- 42 CFR 1001 – Program Integrity – Medicare and State Health Care Programs
- 42 CFR 1002 – Program Integrity – State Initiated exclusions from Medicaid
- 42 CFR 1007 – State Medicaid Fraud Control Units
HealthProviders DB provides data and screening services to assist organizations with exclusion screening and compliance processes. Organizations should independently review and verify screening results, especially when a potential match is identified. The service does not constitute legal, regulatory, or compliance advice and does not guarantee that an organization will satisfy its legal or regulatory obligations.