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State Medicaid Exclusion Lists

By support@poweredbygnosis.com

Health Providers DB profiles include exclusions and suspensions from all the available State Medicaid Exclusion Lists updated monthly.

Avoid potential Civil Monetary Penalties (CMP) by automating the monitoring of your employees and vendors against the HHS-OIG LEIE, GSA-SAM, and all State Medicaid Exclusion Lists, as well as the FDA Clinical Investigators—Disqualification Proceedings and FDA Debarment 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 comply with the following regulations:

(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 Excluded Parties List System (EPLS) (now 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 EPLS (now SAM) no less frequently than monthly.

Healthcare organizations must screen new hires and regularly monitor current employees and individuals and entities they do business with to avoid potential Civil Monetary Penalties.

This includes doctors, nurses, pharmacists, and other professionals interacting with patients and federal healthcare programs like 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 with patients or sensitive healthcare operations in specific settings. While not always required, screening volunteers can help ensure the organization maintains compliance with federal regulations.

Excluded in One State, Excluded in All States

Termination does not mean the same thing as exclusion.

According to a bulletin from the Centers for Medicare and Medicaid Services, “termination” refers to the action taken when a state ends the participation of a Medicaid or Children’s Health Insurance Program (CHIP) provider in the program.

It also applies when the Medicare program revokes a provider or supplier’s billing privileges and the provider can no longer appeal this decision. This means that a state could terminate a provider but the provider might still theoretically work at healthcare organizations if they do not provide services that are billable to Medicare.

The Office of Inspector General (OIG) penalizes healthcare providers by excluding them from participating in federal programs such as Medicare, Medicaid, CHIP, and TRICARE.

When providers are excluded, it becomes difficult for them to continue their practice, as they cannot access these federal healthcare programs.

Although the situations may vary, the outcome remains consistent: a provider’s involuntary exit from the Medicaid program or CHIP.

If a provider is terminated in one state, all other states must also terminate the provider, and the duration of the termination should adhere to the laws of the state where the termination occurred.

For example, if one state terminates a healthcare provider for three years, this termination triggers similar actions in every other state. As a result, employers in the healthcare industry are responsible to both the state and the Office of Inspector General (OIG) for any sanctions, exclusions, or terminations that occur within their employee roster.

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About State Medicaid Exclusion Lists

Each state has a department or agency dedicated to upholding the integrity of Medicaid programs and public health. Though each state enforcement authority can vary by name and function (Department of Medicaid, State OIG, Department of Health Care Services), each outlines the ineligibility rules for licensed providers who have been disciplined or lost certain license privileges.

However, each state publishes its Medicaid exclusion lists in different formats and with varying amounts of data. Most states provide only a name, a possible address when the person or entity was excluded, and maybe a city. This makes identifying a match very difficult and resource-intensive, presenting significant challenges to manual screening processes.

State Medicaid Exclusion List

Only forty-three states currently publish exclusion lists publicly. New Mexico, Oklahoma, Rhode Island, South Dakota, Utah, Virginia, and Wisconsin do not keep a state exclusion list. Instead, you are referred to the Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE).

Alabama

Alabama Medicaid Suspended Providers

Alabama Medicaid Suspended Providers List

Data Dictionary

  • NAME OF PROVIDER
  • SUSPENSION EFFECTIVE DATE
  • SUSPENSION INITIATED BY

Alaska

Alaska Department of Health Medicaid Program Integrity

Alaska Medical Assistance Excluded Provider List .pdf Icon

Data Dictionary

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

Arizona

Arizona Healthcare Cost Containment System

Arizona Medicaid Suspensions and Terminations .pdf Icon

Data Dictionary

  • Name/Provider
  • NPI
  • Action type Suspend-Terminate
  • Effective Date

Arkansas

Arkansas Department of Human Services Excluded Provider Public Search

Arkansas Medicaid Excluded Provider List .csv Icon

Data Dictionary

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

California

California Medi-Cal Providers

California Medicaid Suspended and Ineligible Providers List .csv Icon

Data Dictionary

  • Last Name
  • First Name
  • Middle Name
  • A/K/A-Also Known As D/B/A-Doing Business as
  • Address(es)
  • Provider Type
  • License Number
  • Provider Number
  • Date of Suspension
  • Active Period

Colorado

Colorado Department of Health Care Policy & Financing

Colorado Medicaid Terminated Provider List .xlsx Icon

Colorado Reinstated Provider List .xlsx Icon

Data Dictionary

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

Connecticut

Connecticut Quality Assurance Administrative Actions List

Data Dictionary

  • Name
  • Business
  • Specialty
  • Address
  • Effective Date
  • Period
  • Administrative Action

Delaware

Delaware Program Integrity

Delaware Listing of Sanctioned Providers .pdf Icon

Data Dictionary

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

District of Columbia

District of Columbia Office of Contracting and Procurement Excluded Parties List

Data Dictionary

Reason for the Action

  • Name of Individual
  • Principal Address
  • Action Date
  • Expiration Date
  • Agency Instituting the Action

Florida

Florida Agency for Healthcare Administration .xlsx Icon

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

Georgia

Georgia Department of Community Health

Georgia OIG Exclusions List .xlsx Icon

Data Dictionary

  • NPI
  • LAST NAME
  • FIRST NAME
  • BUSINESS NAME
  • GENERAL
  • STATE
  • SANCDATE

Hawaii

Hawaii Department of Human Service

Hawaii Provider Exclusion/Reinstatement List .pdf Icon

Data Dictionary

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

Idaho

Idaho Department of Health & Welfare .pdf Icon

Data Dictionary

  • Name
  • Exclusion Start Date
  • Date Eligible for Reinstatement
  • Date Reinstated
  • Additional Information

Illinois

Illinois HFS/OIG Provider Sanctions .xlsx Icon

Data Dictionary

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

Indiana

Indiana Family and Social Services Administration

Indiana Terminate Providers .xlsx Icon

Data Dictionary

  • Provider Name
  • NPI
  • Service Location Address
  • Termination Effective Date

Iowa

Iowa Health & Human Services

Iowa Medicaid Sanction List .xlsx Icon

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

Kansas

Kansas Division of Healthcare Finance

Kansas Termination List .xlsx Icon

Kansas Termination List .pdf Icon

Data Dictionary

  • Name
  • Provider Type
  • KMAP Provider #
  • NPI
  • Comments

Kentucky

Kentucky Cabinet for Health and Family Services

Kentucky Medicaid Provider Termination and Exclusion List .xlsx Icon

Kentucky Medicaid Provider Termination and Exclusion List .pdf Icon

Data Dictionary

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

Louisiana

Louisiana Department of Health

Louisiana State Adverse Actions List .csv Icon

Data Dictionary

  • First Name
  • Last Name or Entity Name
  • Birthdate
  • Affiliated Entity
  • Title or Provider Type
  • NPI
  • Reason for Exclusion
  • Period of Exclusion
  • Reason for Termination
  • Type of Exclusion
  • Program Office
  • Period of Enrollment Prohibition
  • Effective Date
  • Reinstate
  • State and Zip

Maine

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

Maryland

Maryland Department of Health Provider Services

Maryland Medicaid Sanctioned Provider List​​​​​​​​​​​​​ .xlsx Icon

Data Dictionary

  • LAST NAME/ORGANIZATION
  • FIRST NAME
  • TYPE OF ENTITY/PROFESSION
  • SANCTION TYPE
  • NPI
  • LICENSE NO
  • TERMINATION/SANCTION DATE
  • ADDRESS
  • CITY/STATE/ZIP

Massachusetts

MassHealth

List of suspended or excluded MassHealth providers .xlsx Icon

List of suspended or excluded MassHealth providers .pdf Icon

Data Dictionary

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

Michigan

Michigan Health & Human Services

List of Sanctioned Providers .xlsx Icon

List of Sanctioned Providers .pdf Icon

Data Dictionary

  • Entity Name
  • Last Name
  • First Name
  • Middle Name
  • Provider Category
  • NPI
  • City
  • License #
  • Sanction Date1
  • Sanction Source
  • Sanction Date2
  • Sanction Source
  • Reason

Minnesota

Minnesota Healthcare Programs

MHCP Excluded Group Providers .xlsx Icon

MHCP Excluded Individual Providers .xlsx Icon

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

Mississippi

Mississippi Division of Medicaid

Mississippi Sanctioned Provider List .xlsx Icon

Data Dictionary

  • Sanction Type
  • Provider Name
  • Provider Address
  • NPI
  • Date of Birth
  • Provider Type/Specialty
  • Termination Effective Date
  • Exclusion Period
  • Termination Reason

Missouri

Missouri Division of Social Services

Missouri Provider Sanctions List .xlsx Icon

Data Dictionary

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

Montana

Montana Healthcare Programs

Missouri Excluded or Terminated Provider List .xlsx Icon

Data Dictionary

  • Authority
  • Terminated/Excluded Provider(s)
  • Healthcare Profession
  • Effective Date

Nebraska

Nebraska Department of Health & Human Services

Nebraska Medicaid Exclu​ded Pr​oviders List .pdf Icon

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

Nevada

Nevada Department of Health & Human Services

Nevada Exclusion List .pdf Icon

Nevada Reinstatement List .pdf Icon

Data Dictionary

  • Excluded Providers/Entities and/or Individuals
  • NPI
  • Medicaid Provider
  • Provider Type
  • Associated Legal Entity
  • Persons with a controlling interest of 5% or more
  • Contract Termination Date
  • Nevada Medicaid Sanction Tier
  • Nevada Medicaid Sanction Period
  • Nevada Medicaid Sanction Period End Date
  • OIG Exclusion Date
  • OIG Reinstate Date

New Hampshire

New Hampshire Department of Health & Human Services

Medicaid Provider Exclusion and Sanction List .xlsx Icon

Data Dictionary

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

New Jersey

New Jersey Medicaid Program

New Jersey Medicaid Ineligible Provider Report .pdf Icon

Data Dictionary

  • PROVIDER NAME
  • TITLE
  • NPI
  • STREET
  • CITY
  • STATE
  • ZIP
  • ACTION
  • EFFECTIVE DATE
  • EXPIRATION DATE

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

New York State Office of the Medicaid Inspector General

New York Medicaid Exclusions List .xlsx Icon

Data Dictionary

  • Provider Name
  • License Num
  • NPI
  • Provider Type
  • Exclusion Effective Date

North Carolina

North Carolina Medicaid Division of Health Benefits

North Carolina Excluded Providers List .xlsx Icon

Data Dictionary

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

North Dakota

North Dakota Health & Human Services

North Dakota Medicaid Provider Exclusion List .pdf Icon

North Dakota Medicaid Provider Exclusion List .xlsx Icon

Data Dictionary

  • Provider Name
  • Provider Verification
  • Business Name and Address
  • Medicaid Provider ID
  • Medicare Provider Number
  • N.P.I.
  • Provider Type
  • State
  • Exclusion Date
  • Reason for Exclusion

Ohio

Ohio Department of Medicaid

Ohio Medicaid Provider Exclusion Suspension List .xlsx Icon

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

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

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. 

Pennsylvania

Pennsylvania Department of Human Services

Pennsylvania Medicheck List .csv Icon

Data Dictionary

  • NBR_FEIN
  • ProviderName
  • LicenseNumber
  • Status
  • BeginDate
  • EndDate
  • CAO
  • ListDate
  • IND_CHGD
  • DTE_CHANGE_LAST
  • NAM_LAST_PROVR
  • NAM_FIRST_PROVR
  • NAM_MIDDLE_PROVR
  • NAM_TITLE_PROVR
  • NAM_SUFFIX_PROVR
  • NAM_PROVR_ALT
  • NAM_BUSNS_MP
  • IDN_NPI

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

South Carolina Department of Health & Human Services

South Carolina Excluded Providers .xlsx Icon

Data Dictionary

  • Individual//Entity
  • NPI
  • City
  • State
  • Zip
  • Last Known Profession/Provider Type
  • Date Excluded

South Dakota

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

Tennessee TennCare Program Integrity

Tennessee Terminated Provider List .pdf Icon

Data Dictionary

  • Last Name
  • First Name
  • NPI
  • Effective Date
  • Reason

Texas

Texas Medicaid Program

Texa Exclusions List .xlsx Icon

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

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

Vermont Medicaid Program

Vermont Medicaid Excluded Providers List .xlsx Icon

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

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

Washington Healthcare Authority

Washington Medicaid Providers Exclusions List .xlsx Icon

Data Dictionary

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

West Virginia

West Virginia Medicaid Management Information System

West Virginia Medicaid Provider Exclusions and Terminations List .pdf Icon

Data Dictionary

  • Last Name
  • First Name
  • NPI
  • Address 1
  • Address 2
  • City
  • State
  • ZIP
  • Action Date
  • Excluded /Terminated
  • Reason for Exclusion /Termination

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

Wyoming Department of Health

Wyoming Provider Exclusion List .pdf Icon

Data Dictionary

  • Last Name
  • First Name
  • Business Name
  • Provider Type
  • Provider Number
  • City
  • State
  • Exclusion Date

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