State Medicaid Exclusion Lists

Avoid potential Civil Monetary Penalties (CMP) by automated monitoring of HHS-OIG LEIE, GSA-SAM, and all State Exclusion Lists, as well as the FDA Clinical Investigators—Disqualification Proceedings and Debarment Lists.

Our Healthcare Provider Profiles include all the available State Medicaid Exclusion Lists.

Each state publishes its exclusion list in different formats with varying amounts of data.

Health Providers DB aggregates and normalizes this data, greatly simplifying your research.

Per 42 CFR Part §455.436 — Federal database checks, State Medicaid agencies must do all of the following:

(a) Confirm the identity and determine the exclusion status of providers and any person with an ownership or control interest or who is an agent or managing employee of the provider through routine checks of Federal databases.

(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 Award Management (SAM) (formerly the Excluded Parties List System (EPLS)), and any such other databases as the Secretary may prescribe.

(c)(1) Consult appropriate databases to confirm identity upon enrollment and re-enrollment; and

(c)(2) Check the LEIE and SAM (formerly the EPLS) no less frequently than monthly.

It is essential for healthcare organizations to screen new hires and regularly check current employees, as well as individuals and entities they do business with, to avoid potential Civil Monetary Penalties (CMP).

Health Providers DB updates the Healthcare Provider Profiles with the State Medicaid Exclusion Lists monthly.

Alaska

Alaska Department of Health Medicaid Program Integrity

Alaska Medical Assistance Excluded Provider List

Data Dictionary

• LAST NAME
• FIRST NAME
• PROVIDER TYPE
• EXCLUSION AUTHORITY
• EXCLUSION DATE
• EXCLUSION REASON

Arkansas Department of Human Services Excluded Provider Public Search

Arkansas Medicaid Excluded Provider List

Data Dictionary

• Division
• Facility Name
• Provider Name
• City
• State
• Zip

Colorado Department of Health Care Policy & Financing

Colorado Medicaid Terminated Provider List

Data Dictionary

• Provider Name
• Doing Business As Name
• NPI
• Termination Authority
• Termination Effective Date

Delaware Program Integrity

Delaware Listing of Sanctioned Providers

Data Dictionary

• Sanctioned Provider Name
• NPI #
• Taxonomy #
• License #
• DEA #
• OIG / Medicaid Sanction
• Year
• Effective Date
• Reinstated Date
• Comments

Florida Agency for Healthcare Administration

Data Dictionary

• Provider
• Medicaid Provider Number
• License Number
• NPI Number
• Provider Type
• Date Rendered
• Sanction Type
• Violation Code
• Fine Amount
• Sanction Date
• AHCA Case Number
• Formal/ Informal Case Number
• Document Type

Hawaii Department of Human Service

Hawaii Provider Exclusion/Reinstatement List

Data Dictionary

• Last Name or Business Name
• First Name
• Middle Initial
• Medicaid Provider ID
• Last known program or provider type
• Exclusion Date
• Reinstatement Date

Illinois HFS/OIG Provider Sanctions

Data Dictionary

• Provider Name
• License #
• NPI
• Provider Type
• Affiliation
• Action Date
• Action Type
• Address
• Address 2
• City
• State
• Zip Code

Iowa Health & Human Services

Iowa Medicaid Sanction List

Data Dictionary

• Enrollment Type
• Specialty
• NPI
• Last Name
• First Name
• Legal Business Name
• Type of Sanction
• Effective Date
• Sanction End Date
• Eligible to Reapply Date
• Authority
• State License Number
• State License Type

Kentucky Cabinet for Health and Family Services

Kentucky Medicaid Provider Termination and Exclusion List

Kentucky Medicaid Provider Termination and Exclusion List

Data Dictionary

• First Name
• Last Name or Practice Name
• NPI
• License
• Effective Date
• Reason for Term/Exclusion

Maine MaineCare Services Provider Exclusion Report

Data Dictionary

• Provider Last Name
• Provider First Name
• Provider MI
• State Exclusion Start Date
• Alias Last Name 1
• Alias First Name 1
• Alias Last Name 2
• Alias First Name 2
• Alias Last Name 3
• Alias First Name 3
• Alias Last Name 4
• Alias First Name 4
• Provider Type

MassHealth

List of suspended or excluded MassHealth providers

List of suspended or excluded MassHealth providers

Data Dictionary

• Provider Name
• Provider Type
• NPI
• Unique ID
• Suspension/Exclusion Reason
• Suspension/Exclusion Effective Date

Minnesota Healthcare Programs

MHCP Excluded Group Providers

MHCP Excluded Individual Providers

Data Dictionary

• Exclusion status
• Provider type Description
• Last name
• First name
• Middle name
• Effective date of exclusion
• Address line1
• Address line2
• City
• State
• Zip code

Missouri Division of Social Services

Missouri Provider Sanctions List

Data Dictionary

• PROVIDER NAME
• NPI
• TERM DATE
• LETTER DATE
• PROV TYPE/SPECIALTY
• LICENSE #
• TERMINATION REASON

Nebraska Department of Health & Human Services

Nebraska Medicaid Exclu​ded Pr​oviders List

Data Dictionary

• ID
• PROVIDER_FIRST_NAME
• PROVIDER_MIDDLE_INITIAL
• PROVIDER_LAST_NAME
• ORGANIZATION_NAME
• NPI
• EFFECTIVE_DATE
• REASON_FOR_ACTION_CODE
• SANCTION_CODE
• SANCTION_TYPE_CODE

New Hampshire Department of Health & Human Services

Medicaid Provider Exclusion and Sanction List

Data Dictionary

• Provider/Individual Last
• Name
• Provider/Individual First
• Name Business Name Provider/Individual Type
• NPI
• Exclusion/Sanction
• Effective Date

New Mexico does not maintain a state exclusion list. Instead, you are referred to the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).

North Carolina Medicaid Division of Health Benefits

North Carolina Excluded Providers List

Data Dictionary

• OWNERSHIP
• EXCLUDED ENTITY
• NPI
• EFFECTIVE DATE
• REASON FOR EXCLUSION
• CITY
• STATE
• ZIP CODE

Ohio Department of Medicaid

Ohio Medicaid Provider Exclusion Suspension List

Data Dictionary

Individuals Tab

• Last Name
• First Name
• DOB
• NPI
• Provider ID
• Status
• Action Date
• Provider Type

Organizations Tab

• Provider Type
• NPI
• Organization Name
• Address 1
• Address 2
• City
• State
• Zip Code
• Provider ID
• Status
• Action Date

Oregon Health Authority

While the state sanction list has been underway, there have not been many Medicaid fraud convictions since 2016. In the spring of 2021, the Oregon Health Authority, mainly responsible for Oregon Medicaid programs, finally added a few provider names to the state list of sanctioned providers for the first time since 2019.

It remains unclear when the balance of provider names, which must be captured on the state list of sanctioned individuals and entities, will be added. 

Rhode Island does not maintain a state exclusion list. Refer to the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).

South Dakota does not maintain a state exclusion list. Instead, you are referred to the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).

Texas Medicaid Program

Texa Exclusions List

Data Dictionary

• Company Name
• Last Name
• First Name
• Mid Initial
• Occupation
• License Number
• NPI
• Start Date
• Add Date
• Reinstated Date
• Eligible To Reapply Date
• Waiver
• Web Comments

Vermont Medicaid Program

Vermont Medicaid Excluded Providers List

Data Dictionary

• VT Medicaid Provider ID
• Provider NPI
• Provider Full Name
• Provider Type
• Provider City
• State
• Status Code
• Reason or “Cause” for Exclusion
• Provider Exclusion Status Effective Date
• Provider Exclusion Status End Date
• Reinstatement Date with Vermont Medicaid, if Applicable

Washington Healthcare Authority

Washington Medicaid Providers Exclusions List

Data Dictionary

• Name
• License #
• NPI
• Date of Exclusion
• Action

Wisconsin does not maintain a state exclusion list. Instead, you are referred to the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).