States must only notify the Health and Human Services (HHS) Office of Inspector General (OIG) when they exclude or terminate an individual or entity based on Federal law.
States are not required to notify the OIG (nor should they) of actions based on State laws because if the sanction fails to meet the criteria for a federal exclusion, the exclusion would not be posted on the LEIE.
Without a separate State sanction list, providers could not determine whether a person or entity had been excluded or terminated.
Also, even if the OIG disagrees with a State action based on federal grounds, by maintaining its list, the State exclusion will stand even if a federal exclusion is not imposed.
State lists are the only way to publish State sanctions and are the fastest and most efficient way to impose sanctions based on federal law.
After a State notifies the OIG, it can still take several months for the OIG to process the State sanction and determine if it will also impose an exclusion. During this lag, the State can enforce the payment prohibition even though those federal payments will still be made to the party it sanctioned!
States may also maintain their list to have a central registry for state sanctions, including non-healthcare actions and exclusions or terminations.
For example, federal exclusions can be imposed for failing to repay federal loans, and it would be reasonable for a State to have a similar exclusion basis.
Similarly, a State might also want to exclude a party for failing to pay State taxes or for failing to provide a variety of other reasons that would not be valid bases for federal exclusions.
Why Don’t all States Maintain a Separate Medicaid Exclusion List?
States aren’t required to maintain their separate exclusion list. States can, instead, treat the OIG’s List of Excluded Individuals and Entities as their “own” list, and seven states have elected to do this: New Mexico, Oklahoma, Rhode Island, South Dakota, Utah, Virginia, and Wisconsin.
Providers should be aware, however, that the States without separate sanction lists focused on healthcare may have other sanction lists that they are required to screen in addition to the LEIE.
For example, the State agencies responsible for contracting may have a separate debarment list; the agency responsible for providing services to those in need of care may maintain a list of persons who may not participate; the State Department of Health might have a list, and so on.
How are the States’ Medicaid Exclusion Lists Different from the OIG’s Exclusion List?
The principal difference is that State lists don’t exclusively contain healthcare sanctions.
They are often used as a centralized list for several sanctions, each of which may have a different impact.
State Medicaid Exclusion lists are also not uniformly maintained or updated or even found in the exact location State by State.
Does Each State Medicaid Exclusion List Have the same data? Are they in the same format? Is Verification the same?
No, No, and No. You would think we have a standard for something this important.
Some State Medicaid Exclusion Lists are in Excel format, others in Word or PDF documents, and others are just HTML web pages.
They also vary widely in the data they contain and how it is presented.
For instance, some State lists have little more than a name, exclusion date, and address. Verification of a State exclusion is also governed on a State-by-State basis.