HealthProviders DB is updated daily with all available State Medicaid Exclusion Lists as they become available, so the database is always up to date.
The State Terminations, Suspensions, Sanctions, and Exclusions are normalized and matched with the Healthcare Providers’ Profile as Exact or Possible matches, greatly simplifying your research.
Uncover an unparalleled solution to effortlessly and simultaneously search OIG Exclusions, SAM Exclusions, State Exclusion Lists, FDA Debarment, and Clinical Investigators—Disqualification Proceedings—all in one powerful platform!
An individual or entity that has been terminated by the state is prohibited from participating in Medicaid or the Children’s Health Insurance Program (CHIP) or has had their billing privileges revoked.
Avoid potential Civil Monetary Penalties (CMP) with HealthProviders DB automated exclusion monitoring.
Federal database check requirements
The Federal Database Checks — 42 CFR Part §455.436 mandate that State Medicaid Agencies must:
(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), 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 no less frequently than monthly.
Who needs to be screened?
Healthcare organizations must screen new hires and regularly monitor current employees, as well as the individuals and entities with whom they do business, to avoid potential Civil Monetary Penalties.
This includes doctors, nurses, pharmacists, and other healthcare professionals interacting with patients and federal healthcare programs, such as Medicare or Medicaid.
Even if someone isn’t directly providing care, they might still be involved in billing, patient records, or managing payments from federal programs. These roles are critical, and OIG exclusion checks should apply here.
Think of anyone supplying medical equipment, pharmaceuticals, or services to a healthcare organization. Just because someone isn’t a full-time employee doesn’t mean they shouldn’t be checked. They must pass an OIG background check if they provide goods or services involving federal funds.
Volunteers can be involved in patient care or sensitive healthcare operations in specific settings. While not always required, screening volunteers can help ensure the organization maintains compliance with federal regulations.
About State Medicaid Exclusion Lists
Every state has a department or agency responsible for upholding the integrity of its Medicaid programs and public health initiatives. While the names of these enforcement authorities may differ—such as the Department of Medicaid or the Department of Health Care Services—they all establish rules regarding the ineligibility of providers who have been disciplined or have lost specific licensing privileges.
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) for terminations and exclusions based on state laws, because if the sanction fails to meet the criteria for a federal exclusion, it will not be included on the OIG List of Excluded Individuals/Entities (LEIE).
For instance, a state might exclude a party for failing to pay state taxes or for a variety of other reasons that would not be valid bases for federal exclusion.
For this reason, states maintain a list of individuals and entities that are terminated, suspended, sanctioned, or otherwise excluded from the State Medicaid program based on state law.
States may also maintain their list as a central registry for state sanctions, which include other 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.
States are not required to maintain a state exclusion list, and seven states have elected not to: New Mexico, Oklahoma, Rhode Island, South Dakota, Utah, Virginia, and Wisconsin.
This is a problem because, without a separate state sanction or exclusion list, it is difficult to determine if an individual or entity has been excluded or terminated in that state based on state law.
State Exclusion Lists
Each state publishes its exclusion lists in different formats and with varying levels of detail. Some states provide only the name of the excluded individual or entity, along with a possible address and sometimes just a city.
HealthProviders DB imports all State Medicaid Exclusion Lists when they become available each month, so the database is always up to date.
All state terminations, suspensions, sanctions, and exclusions are normalized and matched with the Healthcare Providers’ Profile as Exact or Possible matches, greatly simplifying your research.
Alabama
Alabama Medicaid is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Alabama Suspended Providers monthly.
Alaska
The Alaska Department of Health Division of Public Assistance Services (DPA) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Alaska Medical Assistance Excluded Providers monthly.
Arizona
Arizona Health Care Cost Containment System (AHCCCS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Arizona Provider Suspensions and Terminations monthly.
Arkansas
The Arkansas Department of Human Services Division of Medical Services (DMS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Arkansas Excluded Providers monthly.
California
The Department of Health Care Services (DHCS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the California Suspended and Ineligible Providers monthly.
Colorado
The Colorado Department of Health Care Policy & Financing (HCPF) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Colorado Terminated Providers monthly.
Connecticut
The Department of Social Services (DSS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Quality Assurance Administrative Actions monthly.
Delaware
The Delaware Health and Social Services (DHSS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Delaware Sanctioned Providers monthly.
District of Columbia
The DC Office of Contracting and Procurement (OCP), under the direction of the Chief Procurement Officer, provides contracting services for selected agencies and offices in the District.
HealthProviders DB imports the DC Excluded Parties monthly.
Florida
The Florida Agency for Health Care Administration is responsible for administering the Statewide Medicaid Managed Care (SMMC) program.
HealthProviders DB imports the Florida Medicaid Terminated Providers monthly.
Georgia
The Georgia Department of Community Health (DCH) Office of Inspector General (OIG) safeguards the integrity of the DCH from internal and external risks.
HealthProviders DB imports the Georgia List of Excluded Individuals monthly.
Hawaii
Med-QUEST (Quality, Universal Access, Efficiency, Sustainability, Transformation) is the agency that administers the state’s Medicaid program, a division of the State of Hawai’i Department of Human Services.
HealthProviders DB imports the Hawaiʻi Excluded Providers monthly.
Idaho
Idaho Department of Health & Welfare is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Idaho Medicaid Exclusion monthly.
Illinois
The Illinois Department of Healthcare and Family Services (HFS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the HFS/OIG Provider Sanctions monthly.
Indiana
The Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) effectively administers Medicaid programs for the state of Indiana.
HealthProviders DB imports the Indiana Terminated Providers monthly.
Iowa
The Iowa Department of Health and Human Services (HHS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Iowa Excluded Individuals and Entities monthly.
Kansas
The Kansas Department of Health and Environment Division of Health Care Finance is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Kansas Medicaid Terminated Providers monthly.
Kentucky
The Cabinet for Health and Family Services Department for Medicaid Services is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Kentucky Terminated and Excluded Providers monthly.
Louisiana
The Louisiana Department of Health (LDH) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Louisiana Adverse Actions monthly.
Maine
The MaineCare Services, an Office of the Department of Health and Human Services (DHHS), is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the MaineCare List of Excluded Individuals/Entities monthly.
Maryland
The Maryland Department of Health is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Maryland Medicaid Sanctioned Providers monthly.
Massachusetts
Search Massachusetts Exclusions
MassHealth is the agency that administers the Massachusetts Medicaid program.
HealthProviders DB imports the Suspended and Excluded MassHealth Providers monthly.
Michigan
The Michigan Department of Health and Human Services (MDHHS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the MDHHS Sanctioned Providers monthly.
Minnesota
Minnesota Health Care Programs (MHCP) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the MHCP Excluded Individual Providers monthly.
Mississippi
Mississippi Division of Medicaid is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Mississippi Sanctioned Providers monthly.
Missouri
Missouri Medicaid Audit & Compliance (MMAC) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Missouri Provider Sanctions monthly.
Montana
The Montana Department of Public Health & Human Services (DPHHS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Montana Excluded and Terminated Providers monthly.
Nebraska
The Nebraska Department of Health and Human Services, Division of Medicaid & Long-Term Care, is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Nebraska Excluded Providers monthly.
Nevada
Nevada Medicaid is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Nevada Provider Sanctions monthly.
New Hampshire
Search New Hampshire Exclusions
The New Hampshire Department of Health and Human Services (DHHS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the New Hampshire Provider Exclusions and Sanctions monthly.
New Jersey
The New Jersey Department of Human Services, Division of Medical Assistance and Health Services, is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the New Jersey Provider Disqualifications, Suspensions, Debarments, and Terminations monthly.
New Mexico
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).
New York
Search New York State Exclusions
The New York State Office of the Medicaid Inspector General (OMIG) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the NYS Provider Exclusions monthly.
North Carolina
Search North Carolina Exclusions
NC Medicaid, Division of Health Benefits (NCDHHS), is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the NC Provider Terminations and Exclusions monthly.
North Dakota
Search North Dakota Exclusions
North Dakota Health and Human Services (NDHHS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the North Dakota Provider Exclusions monthly.
Ohio
The Ohio Department of Medicaid (ODM) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Ohio Provider Exclusions and Suspensions monthly.
Oklahoma
Oklahoma does not maintain a state exclusion list. Instead, you are referred to the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).
Oregon
The Oregon Health Authority Program Integrity Audit Unit (PIAU) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Oregon Fraud Convictions monthly.
Pennsylvania
Search Pennsylvania Exclusions
The Pennsylvania Department of Human Services (DHS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Pennsylvania Medicheck Precluded Providers monthly.
Rhode Island
Rhode Island does not maintain a state exclusion list. Refer to the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).
South Carolina
Search Soth Carolina Exclusions
The Department of Health and Human Services (SCDHHS) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the South Carolina Excluded/Terminated Providers monthly.
South Dakota
Search South Dakota Exclusions
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).
Tennessee
The TennCare is the agency that administers the Tennessee State Medicaid program.
HealthProviders DB imports the Tennessee Terminated Providers monthly.
Texas
Texas Health and Human Services is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Texas Provider Excusions monthly.
Utah
Utah does not maintain a state exclusion list. Instead, you are referred to the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).
Vermont
The Agency of Human Services Department of Vermont Health (DVHA) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Vermont Excluded Providers monthly.
Virginia
Virginia does not maintain a state exclusion list. Instead, you are referred to the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).
Washington
The Health Care Authority (HCA) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the HCA Provider Terminations and Exclusions monthly.
West Virginia
Search West Virginia Exclusions
The West Virginia Department of Human Services Bureau of Medical Services is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the West Virginia Provider Exclusions and Terminations monthly.
Wisconsin
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).
Wyoming
The Wyoming Department of Health (WDH) is the agency that administers the state’s Medicaid program.
HealthProviders DB imports the Wyoming Provider Exclusions monthly.