Quickly search all State Medicaid Provider Termination Lists at once, greatly simplifying your monthly Exclusions Monitoring and Screening requirements.
Providers excluded by the Office of Inspector General (OIG) or terminated by any State Medicaid Agency cannot participate in Medicaid, TRICARE, and the Children’s Health Insurance Program (CHIP) federally funded healthcare programs.
In addition, a provider whose billing privileges have been revoked by the Centers for Medicare & Medicaid Services (CMS) or any State Medicaid Agency is prohibited from participating in Medicare.
Search all Exclusions at Once
HealthProviders DB is an extensive database featuring over 9 million comprehensive Healthcare Provider Profiles!
Search OIG Exclusions, SAM Debarments, and all State Medicaid Provider Termination Lists at once.
Exclusions are imported monthly as they become available, keeping the Healthcare Provider Profiles up-to-date.
Enter an NPI number, license number, or provider name in the search field below to search all Exclusions.
Alternatively, you can also search the Providers.
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Select a State to view the list of Exclusions by State. Additionally, you can narrow the list by city, among other options, from the Filter Panel, which you can open by clicking the vertical ellipses ⋮ in the upper right corner of the app.
Avoid potential Civil Monetary Penalties with Batch Exclusions Screening & Automated Exclusion Monitoring Subscriptions.
Frequently Asked Questions
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.
Plus, it can take several months for the OIG to process the State-reported sanction, determine whether it will also impose a federal exclusion based on a violation of federal laws, and post it to the LEIE.
For instance, a State might exclude a party for failing to pay State taxes or for other reasons that would not be valid bases for federal exclusion. For this reason, states maintain a list of individuals and entities who are terminated, suspended, sanctioned, or otherwise excluded from the State Medicaid program under State law.
The key difference is that federal exclusion lists do not include state exclusions; thus, the State list is where to find exclusions based on violations of State laws.
Another difference is that some State lists don’t exclusively contain healthcare sanctions. They are a centralized list of several sanctions, each with a different impact. This is similar to the System for Award Management (SAM), which includes debarments beyond healthcare.
States aren’t 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.
These states may have other sanction lists. For example, State agencies responsible for contracting may maintain a separate debarment list; the agency responsible for providing services to those in need of care may maintain a list of individuals who cannot participate; or the State Department of Health might maintain its own list, and so on.
You’d think we would have a standard for something this important, but sadly, no.
Unfortunately, each State that publishes an exclusion list uses a different format and varies in level of detail.
Some lists are in Excel format, others are in Word or PDF, and some are simply HTML web pages.
Information available in State Exclusion Lists can also vary widely, with some that include little more than a name and address.
HealthProviders DB is a comprehensive national database that consolidates all State Medicaid Exclusion Lists to ensure you have access to the most up-to-date and accurate information available.
Section 6501 of the Affordable Care Act (ACA), Termination of Provider Participation Under Medicaid if Terminated Under Medicare or Other State Plan, requires State Medicaid programs and the Children’s Health Insurance Program (CHIP) to terminate the participation of any individual or entity that has been terminated from Medicare or any other State’s Medicaid program for cause.
This provision is intended to enhance program integrity by ensuring that federal funds do not reach providers excluded for serious offenses, such as fraud or abuse, regardless of the originating State’s termination.
However, a terminated provider could still work at healthcare organizations if they don’t provide services that are billable to Medicare. If they don’t bill Medicare directly for their services, they can still work in administrative roles at healthcare organizations.
For instance, a nurse practitioner who has been terminated (but not excluded) from Medicare could take on a different position at a hospital, as long as the services provided are not directly billable to Medicare.
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, “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.