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Virginia Exclusion Screening Requirements
The HHS Office of Inspector General (HHS-OIG) has the authority to exclude individuals and entities from participation in Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and all Federal health care programs as defined in section 1128B(f) of the Social Security Act (the Act).
Federal regulations require State Plans for Medical Assistance establish and implement statewide controls to safeguard against unnecessary or inappropriate utilization of healthcare services and payments.
Virginia follows federal law, meaning providers convicted of Medicare/Medicaid fraud, patient abuse, or felony drug offenses are excluded from all federal programs, including Medicaid.
Virginia does not maintain a State exclusion list; however, Section 4.6G in the Virginia Medallion 4.0 Managed Care Services Agreement states that the Contractor shall conduct monthly checks and shall require subcontractors to conduct monthly checks to screen non-Medicaid-enrolled providers for exclusion.
Virginia does not maintain a State exclusion list; nevertheless, providers must screen for excluded individuals participating in or applying to participate in the Medicare and Medicaid programs by searching the following exclusion lists monthly to ensure existing employees or contractors, and new hires, have not been excluded from participation:
- 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 other databases as the State may prescribe.
Virginia Primary Source License Lookup
Virginia Disciplinary Actions
Virginia Licensing Boards
Department of Health Professions
- Virginia Board of Audiology and Speech-Language Pathology
- Virginia Board of Counseling
- Virginia Board of Dentistry
- Virginia Board of Long-Term Care Administrators
- Virginia Board of Medicine
- Virginia Board of Nursing
- Virginia Board of Optometry
- Virginia Board of Pharmacy
- Virginia Board of Physical Therapy
- Virginia Board of Psychology
- Virginia Board of Social Work
- Virginia Board of Veterinary Medicine