FAQ Archives

Provider Termination FAQs

February 16, 2025August 28, 2025

Sanctions, Exclusions, Terminations, Suspensions, and Debarment are administrative actions taken against an individual or entity by the Office of Inspector General (OIG), State Healthcare Program Agencies, the Medicaid Fraud Control Unit (MFCU), or one of the many agencies associated with the General Services Administration (GSA), for reasons that include fraud, integrity, or quality. For healthcare organizations, an individual or entity that is sanctioned or excluded by the OIG, terminated by a State Healthcare Program authority, or suspended or debarred by the GSA is prevented from participating in any Federal Healthcare Reimbursement Program, including Medicaid, CHIP, and Medicare programs, regardless ofLearn MoreProvider Termination FAQs

How to File a Complaint with Medicare

December 1, 2024August 21, 2025

Medicare receives over 100,000 complaints annually. You’re not alone if you’re dissatisfied with any aspect of the federal healthcare program. You might be wondering how to express your concerns. Frequently Asked Questions What is a grievance with Medicare? A Medicare grievance is a patient’s dissatisfaction with any aspect of a health care provider’s service or even the health care plan itself. It can be for reasons such as an inability to schedule an appointment with an approved Medicare provider or feeling like you were treated poorly by a doctor, nurse, or other medical staff member. How do I file aLearn MoreHow to File a Complaint with Medicare

Exclusion Lists FAQs

December 1, 2024August 17, 2025

Which exclusion list should I use to check employees and vendors, the OIG-LEIE or the GSA-SAM? It is recommended that you check both the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) and the General Services Administration’s (GSA) System for Award Management (SAM) databases, as well as all of the publicly available State Exclusion Lists. According to 42 CFR Part §455.436(b) — Federal database checks, State Medicaid agencies must: (b) Check the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), the System for AwardLearn MoreExclusion Lists FAQs

NPI Number Frequently Asked Questions

November 12, 2024August 20, 2025

The Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification required the adoption of a standard for a unique health identifier for healthcare providers. The NPI Final Rule, published on January 23, 2004, established the NPI unique identification number as this standard. Covered healthcare providers, health plans, and clearinghouses must use NPIs in administrative and financial transactions. The Centers for Medicare & Medicaid Services (CMS) developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. For more information on how to apply for an NPI, visit https://nppes.cms.hhs.gov/NPPES/Welcome.do. What Is an NPI? A National Provider Identifier (NPI) is aLearn MoreNPI Number Frequently Asked Questions

SAM Suspension and Debarment FAQs

November 12, 2024August 20, 2025

What are Suspension and Debarment? Suspensions and debarments are “administrative remedies” used to prevent the Government from working with parties who are not “presently responsible”. An individual or entity is not presently responsible if they engaged in criminal activity or other improper conduct, or have demonstrated serious poor performance to such a severe and compelling nature that it would lead to questioning their honesty, ethics, or competence. Federal agencies use these remedies to exclude parties from obtaining new Federal contracts, certain subcontracts (procurement), discretionary assistance, certain funded lower-tiered transactions, leases, loans, loan guarantees, and other benefits (non-procurement). Both suspended andLearn MoreSAM Suspension and Debarment FAQs

State Exclusion List FAQs

November 12, 2024August 22, 2025

Why do States have an Exclusion List? States are required to notify the Health and Human Services (HHS) Office of Inspector General (OIG) only 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 will not be posted on the LEIE. It can take several months for the OIG to process the State-reported sanction and determine if the OIG will also impose a federal exclusion based onLearn MoreState Exclusion List FAQs