Search the Iowa Medicaid Sanction List, OIG Exclusions, SAM.gov, and all State Medicaid Exclusion lists at once to make Exclusion Screening easier.
Enter an NPI number, license number, or provider name in the search field below to search Iowa exclusions.
Alternatively, you can also search all Exclusions and the Healthcare Provider Profiles.
Iowa Exclusion Screening Requirements
Providers excluded by the OIG or terminated by a State Medicaid Agency cannot participate in federally funded healthcare programs. This includes 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 must screen both current employees and new hires for exclusions from participating in the Medicaid program, and may face Civil Monetary Penalties (CMP) if they fail to ensure that proper exclusion screening has been conducted.
In addition, 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.
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- Maintain compliance with federally funded healthcare programs.
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Non-compliance can be severe!
- Required repayment of claims.
- Costly Civil Monetary Penalties.
- Loss of access to federally funded healthcare programs.
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Frequently Asked Questions
Requirement
Federal database checks—42 CFR Part § 455.436 requires all Medicare Advantage Plans, all State Medicaid Programs, and all Medicaid Managed Care Organizations to confirm through routine Federal database checks the exclusion status of providers.
Compliance
The Office of Inspector General (OIG) mandates screening to prevent fraud, abuse, and patient neglect.
Financial Risk
Hiring an excluded individual can result in substantial Civil Monetary Penalties (CMPs) and repayment obligations.
According to the OIG’s Special Advisory Bulletin issued in May 2013, the OIG recommends that healthcare organizations check their employees and contractors against the LEIE monthly.
42 CFR Part § 455.436(c)(2) Federal database checks states to “check the LEIE and SAM no less frequently than monthly.”
Monthly screening is mandatory in at least 14 States, while many others strongly recommend that providers screen employees and vendors against their State lists and the LEIE monthly.
Healthcare organizations must conduct exclusion screening for 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.
Furthermore, the OIG has emphasized that civil monetary penalties are most likely when excluded individuals provide essential services to patient care.
Learn more about who needs to be screened for Medicare Exclusion.
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Features Include:
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✓ Automatic Exclusions Change Notifications.
✓ Detailed Exclusions Dashboard with total Providers, Exclusions, Verifications, Reinstatements, Medicare Out-of, and NPI deactivations.
✓ Primary Source Exclusion Verification Tools.
✓ The ability to Save Notes & Documented Evidence of Exclusion Screening.