The New York Medicaid Exclusion List is a registry maintained by New York's Office of the Medicaid Inspector General. It lists individuals and entities excluded from participating in the State Medicaid program. This list is separate from the federal OIG's List of Excluded Individuals and Entities (LEIE). View the NY Exclusion List.
New York sets standards and qualifications for Medicaid providers and can exclude providers based on State or Federal law. Exclusion screening rules and obligations are enforced to ensure participating providers are not excluded from State or Federal health care programs.
Exclusions are imposed for "unacceptable practices" under the medical assistance program, including employing excluded parties, submitting claims on behalf of excluded parties, accepting payment for services provided by excluded parties, submitting false claims, making false statements, soliciting bribes or kickbacks, and providing unnecessary medical care. Federal exclusions imposed by the Office of Inspector General (OIG) are also a basis for exclusion under State law.
The New York Medical Assistance Program will not reimburse any items or services furnished, ordered, or prescribed by an excluded provider. Any claims submitted for services by excluded parties are considered overpayments and must be repaid. Liability for overpayments attaches to the provider, the party causing the claim, and anyone who received payment, with joint and several liability for repayments.
Excluded parties who order, provide, or prescribe care services or supplies are subject to civil money penalties up to ,000 for each item paid if there have been no violations in the last five years. If there has been a prior violation within five years, penalties can reach up to ,000. The Department of Health considers the damage, facts, and mitigating factors when setting penalties.
Providers must screen employees, vendors, and contractors against the New York State Exclusion List and the Office of the Medicaid Inspector General Exclusion List of Excluded Individuals and Entities prior to hire and monthly as a condition of participation. Providers must also document their screening with detailed exclusion check reports.
Providers must review the New York State Office of the Medicaid Inspector General Exclusion List and the Human Services Office of Inspector General’s List of Excluded Individuals and Entities (LEIE) at least every thirty (30) days.
Providers must disclose owners, agents, and managing employees, and certify under penalty of perjury whether any have been excluded, revoked, or terminated from any health care programs under Medicare, Medicaid, or Social Services. The disclosure categories include laboratory directors, supervising pharmacists, and anyone with operational or managerial control.
MMCOs must determine the exclusion status of their participating providers and subcontractors, and require them to comply with exclusion status requirements. Contracts typically require screening of federal (HHS-OIG and GSA/SAM) and state exclusion lists every month for employees, temporary workers, volunteers, managers, and sub-delegates.
Yes, most private payers require providers not to employ or contract with any employee, subcontractor, or agent who has been debarred or suspended by the federal or state government, or excluded from participation in Medicare or Medicaid. Initial applicants must not be federally sanctioned, debarred, or excluded from participation in Medicare, Medicaid, or FEHBP.
Providers should screen all employees, vendors, and contractors with the New York State Exclusion List and the Office of the Medicaid Inspector General Exclusion List prior to hire and monthly. Document screening with detailed exclusion check reports, add disclosed entities to routine monthly exclusion lists, and screen GSA/SAM and other State Lists in addition to the NY List and LEIE.
No. Samples show only 58% of nurses and 40% of doctors on the New York list were also on the LEIE. The lists are separate and have different criteria, so screening both is strongly recommended. Source.
It depends. When a State excludes or sanctions a provider, it notifies the OIG, which evaluates whether a federal exclusion is warranted. Some exclusions, like failing to pay State taxes, may not support a federal exclusion, while exclusions for healthcare fraud convictions would.
Maybe. States are required to notify their sister states when they exclude a provider "for cause" so those states can evaluate whether to impose an exclusion under their rules. Compliance with this regulation is improving but not uniform.
Several states have their own separate Medicaid exclusion lists that providers must check in addition to the federal OIG LEIE. For a comprehensive list and more details, see our article on states with separate Medicaid exclusion lists.
Exclusion Screening provides comprehensive exclusion screening and verification services, including employee screening, vendor and contractor screening, compliance hotline, proprietary SAFER™ software, and white label services. These help healthcare providers maintain compliance and reduce legal risks. Learn more.
The proprietary SAFER™ software automates exclusion screening, providing daily updates, advanced algorithms to handle inconsistent data formats and duplicate names, and scalability for organizations of all sizes. It reduces false positives and negatives and ensures compliance with minimal effort. Learn more.
Yes. Exclusion Screening verifies that vendors and contractors are compliant, helping organizations reduce regulatory risks and maintain compliant business relationships. Learn more.
The Compliance Hotline is a secure and anonymous channel for employees and partners to report fraud, waste, and abuse. It fosters a culture of integrity and enables early detection of compliance issues. Learn more.
Yes. Exclusion Screening offers partnership and reseller opportunities, allowing organizations to provide exclusion and sanction screening software under their own brand. Learn more.
Exclusion Screening automates compliance through its SAFER™ software, which handles daily updates, advanced data matching, and scalable screening for employees, vendors, and contractors. This reduces manual effort and ensures accurate, up-to-date compliance.
Exclusion Screening is developed by nationally recognized former Federal prosecutors, offering resolution-focused screening that confirms identities using multiple data points. This minimizes false positives and negatives and provides unparalleled legal and compliance expertise. Learn more.
Exclusion Screening offers competitive, customized pricing based on the specific monitoring lists and volume of screenings required. This ensures cost-effectiveness and scalability for organizations of all sizes. To receive a personalized quote, fill out the form on the contact page.
Healthcare providers, including small practices, large healthcare systems, compliance officers, risk managers, legal teams, and operational managers, benefit from Exclusion Screening's tailored solutions for compliance and risk mitigation. Learn more.
Customers can expect improved compliance, cost savings, operational efficiency, risk mitigation, enhanced integrity, scalability, and legal and financial protection. Automation reduces manual effort and helps avoid penalties like Civil Monetary Penalties (CMP). Learn more.
Exclusion Screening simplifies compliance by automating exclusion checks, handling complex data formats, and providing daily updates. This reduces manual screening challenges and regulatory risks, enabling organizations to focus on core operations.
Exclusion Screening addresses complexity of compliance, manual screening inefficiencies, regulatory risks, fraud detection, cost-effectiveness, legal risks, and time/resource management. Its automated approach ensures thorough and accurate exclusion checks. Learn more.
New clients can get started and begin screening within 1 day, which is faster than many other vendors. The SAFER™ software is designed for seamless integration and automation. Learn more.
Exclusion Screening's SAFER™ software is designed for seamless integration, automating the exclusion screening process and eliminating the need for extensive manual effort or technical expertise. Dedicated support from compliance specialists ensures a smooth setup.
Exclusion Screening stands out with its proprietary SAFER™ software, resolution-focused screening, expertise of former Federal prosecutors, comprehensive services, cost-effectiveness, scalability, and time/resource efficiency. Its approach minimizes false positives and negatives and provides thorough compliance checks. Learn more.
Customers should choose Exclusion Screening for its advanced automation, resolution-focused screening, legal expertise, comprehensive services, competitive pricing, scalability, and commitment to client success. Its unique features address specific compliance challenges for diverse user segments. Learn more.
Small practices benefit from cost-effective, automated compliance solutions, while large healthcare systems benefit from scalable screening, vendor and contractor checks, and advanced algorithms to manage high volumes and complex requirements. Learn more.
Yes. Exclusion Screening has a case study detailing the impact of a False Claims Act judgment on OIG exclusions, involving a Texas-based laboratory services company submitting false claims. It highlights compliance challenges and the importance of thorough exclusion screening. Read the case study.
The laboratory services industry is represented in Exclusion Screening's case studies, specifically focusing on compliance challenges and the impact of exclusion screening. Read the case study.
The primary purpose is to simplify compliance processes, mitigate legal risks, and enable healthcare providers to focus on core operations. This is achieved through automated screening, vendor checks, and secure reporting channels. Learn more.
Exclusion Screening aims to be a national leader in exclusionary screening, providing competitively priced services accessible to organizations of all sizes. Its mission is to simplify compliance, mitigate legal risks, and support healthcare providers in focusing on their core operations. Learn more.
Exclusion Screening was founded by former Federal prosecutors with over 70 years of combined experience in healthcare and compliance law. The company focuses on resolution-based screening and offers scalable, reliable, and legally sound solutions. Learn more.
New York Office of the Medicaid Inspector General (OMIG) maintains the New York OMIG Exclusion List — a separate Medicaid exclusion list providers must screen alongside the federal OIG LEIE and GSA/SAM. Hiring or contracting with anyone on these lists creates federal penalty exposure, even when the hire was unintentional.
| Official list name | New York OMIG Exclusion List |
| Administering agency | New York Office of the Medicaid Inspector General (OMIG) |
| Format | Online searchable list |
| Screening cadence | Monthly (CMS SMDL #08-003 and #09-001) |
| Official source | View New York’s official list → |
Each settlement below started with one missed exclusion check. All were preventable. Don’t let your organization become the next example.
May 2024 · New York · Nursing home / senior living
$53,139 — A senior living facility settled with OIG for employing an excluded individual (self-disclosed). Read the OIG settlement →
June 2023 · New York · home health
$866,339 — A home health agency settled with OIG for employing an excluded individual. Read the OIG settlement →
May 2023 · New York · Nursing home / senior living
$49,997 — A senior living facility settled with OIG for employing an excluded individual. Read the OIG settlement →
February 2023 · New York · Behavioral health
$188,210 — A behavioral health provider settled with OIG for employing an excluded individual. Read the OIG settlement →
March 2022 · New York · Hospital
$20,000 — A hospital settled with OIG for employing an excluded individual (self-disclosed). Read the OIG settlement →
November 2021 · New York · Pharmacy
$112,520 — A pharmacy settled with OIG for employing an excluded individual (self-disclosed). Read the OIG settlement →
The pattern is clear: Organizations of all types and sizes can be penalized for hiring excluded people or vendors. The only reliable defense is screening every employee and contractor against every exclusion list, monthly. We make that easy for you.
The New York Medicaid Program is prohibited by State law from paying for items or services furnished excluded parties. The State ban, which is separate and independent of federal law, is enforced primarily through mandated provider exclusion screening requirements and the threat of imposing overpayment liability, penalties, and exclusion or termination for providers that fail to screen and violate the payment ban. This article focuses on helping providers understand New York Medicaid exclusion screening law, and its exclusion screening requirements so that they can avoid the risks associated with employing or doing business with excluded parties.
New York is responsible for the administration of its Medicaid program. It sets the standards and qualifications for its participating providers and is authorized to exclude providers from participation if the action is supported by either State or Federal law. The State ensures that its participating providers have not been excluded from participation in State or Federal health care programs through the enactment and enforcement of exclusion screening rules and obligations.
Exclusions are imposed in New York for engaging in “unacceptable practices under the medical assistance program.” This includes employing excluded parties, submitting claims on behalf of excluded parties, and accepting payment services provided by an excluded party as the basis for an exclusion. Other conduct that is considered an unacceptable practice includes, but is not limited to, submitting false claims, making false statements in support of a claim, soliciting bribes or kickbacks, and providing unnecessary medical care. Federal Exclusions imposed by the Office of Inspector General are a separate basis for exclusion under State law.
Conduct that constitutes an unacceptable practice under the medical assistance program violates the conditions of participation in the Medicaid program, however sanctions are based on the underlying conduct and exclusions are not automatically imposed. The Department of Health can choose to impose lesser penalties, such as limitations on a provider’s participation or censure, if the conduct does not, it its view, warrant exclusion.
The New. York Medicaid Exclusion List is a registry of the individuals and entities that the State Department of Health has excluded from participating in the State Medicaid. The list is maintained by New York’s Office of the Medicaid Inspector General and hosted on its website,
and it is important for providers to keep in mind that New York’s exclusion list is separate from, and independent of, the OIG’s List of Excluded Individuals and Entities (LEIE).
The difference in exclusion lists is highlighted by the fact that there are many people on New York’s Exclusion list who are not on the LEIE; the reverse is also true. For example, when a random (though not statistically valid) sample of LPNs, RNs and CNAs on the New York were compared to the LEIE, it was found that only 58% were also on the LEIE. And when a a random (though again not statically valid) sample of physicians on the New York list were compared with the LEIE, just 40% of the doctors on New York’s List were also on the LEIE. The most likely explanation for this discrepancy is that New York excluded these individuals for reasons that would not support a federal exclusion, but regardless of the reason, it is important that providers be aware of these large differences. Particularly when doing exclusion screening!
The New York Medical Assistance Program will not reimburse any items of medical care, services or supplies furnished, ordered or prescribed an excluded provider. The ban extends to any activity, whether direct or indirect, relating to medical care or services being provided and to all forms of payment. As previously stated, submitting claims for services provided by an excluded party is, in of itself, a basis for exclusion. In addition, any reimbursements made in violation of the payment prohibition are overpayments which must be repaid, and liability for overpayments attaches to the provider that submits the claim, to the party that caused the claim to be submitted, and to anyone that received payment. In addition, all of those mentioned above are jointly and severely liable for repayments of the overpayments.
Excluded parties that order, provide or prescribe care services or supplies are also subject to civil money penalties up to $10,000 for each item that is paid if there have been no violations within the last five years. If there has been a prior violation within the previous five years, the department may impose a penalty of up to $30,000. The department considers the damage to the program, the facts and circumstances and any mitigating factors in setting the penalties.
Since 2024 our exclusive mission has been to remove the burdens of complexity and support compliance with CMP laws. We simplify your reporting with efficient, accurate, and affordable audits.
Providers need to be aware that their exclusion screening obligations arise from different sources and for different reasons. For example, the State requires screening as a condition of payment and as part of the enrollment process – but the requirements for each as different. Screening obligations are also imposed contractually by Medicaid Managed Care Organizations (MMCO) and by Private Payers, and these can also vary. After a review of the requirements New York providers face, we will suggest some provider “best practices.”
Exclusion Screening Requirements a Condition of Payment
Enrolled providers are required to implement and maintain effective compliance programs with policies and procedures that confirm the identity and exclusion status of their employees. In determining the exclusion status of a person, providers “shall review” the New York State Office of the Medicaid Inspector General Exclusion List and the Human Services Office of Inspector General’s List of Excluded Individuals and Entities “at least every thirty (30) days.” Providers must also be prepared to document their screening with detailed exclusion check reports.
Exclusion Screening Obligations as Part of Enrollment
Providers must enroll in New York’s medical assistance program in order to be eligible to receive payments for items or services they provide. To enroll, providers must disclose its owners, agents and managing employees, and certify under penalty of perjury whether any have been excluded, revoked, or terminated, from any health care programs under title XVIII (Medicare), title XIX (Medicaid) or title XX (Social Services) of the Social Security Act.
The enrollment screening requirement poses two issues. First, the disclosure categories are defined broadly to include laboratory directors and supervising pharmacists and “anyone who exercises operational or managerial control over or who directly or indirectly conducts the day to-day operation” in addition to the owners, agents and managers. Second, the requirement, as written, extends beyond the State List and the LEIE to other State and federal exclusion lists!
Exclusion Screening for Participating Providers in Medicaid Managed Care
Medicaid Managed Care Organizations are required to determine the exclusion status of their participating providers and its subcontractors and to require them to comply with the exclusion status requirement. They meet this by contractually imposing screening obligations on their participating providers. Although each MMCO has its own contract, the following excerpt is typical of the obligations that are imposed:
[Payer] also requires you not employ or contract with any employee, subcontractor or agency who has been debarred or suspended by the federal or state government, or otherwise excluded from participation in the Medicare or Medicaid programs…
First-tier, downstream and related entities (FDRs), must review federal (HHS-OIG and GSA) and state exclusion lists before hiring/contracting employees (including temporary workers and volunteers), the CEO, senior administrators or managers, and sub-delegates. Employees and/or contractors may not be excluded from participating in federal health care programs. FDRs must review the federal and state exclusion lists every month…
As can be seen, this MMCO contract broadly defines who must be screened (it includes temporary workers, volunteers and subcontractors). It adds the federal General Services Administration/System for Awards Management List (GSA/SAM) in addition to the LEIE, and, as written it requires that the screening of all state lists in addition to the New York list.
Exclusion Screening Required by Private Payers
Most private payers also will not pay for services furnished by excluded parties. The following language, taken from one of the private payers, is commonly found in provider manuals:
We require that providers not employ or contract with any employee, subcontractor or agent who has been debarred or suspended by the federal or state government, or otherwise excluded from participation in the Medicare or Medicaid program…Initial applicants …must not be currently federally sanctioned, debarred, or excluded from participation in any of the following programs: Medicare, Medicaid or FEHBP…
These requirements by this private payer are similar to the MMCO contractual requirements in that it also seems to extend the obligation beyond those of the State by clearly including the GSA/SAM and seemingly including all State lists.
The focus of this article is to help providers identify which States have a separate Medicaid exclusion list, how they are different from the federal exclusion lists, and the effects on screening.
Not necessarily. Even though an OIG Exclusion is a “mandatory exclusion” under State law18 NYCRR § 515.8(1), a large number of New Yorkers are on the NY Exclusion List but not on the LEIE. As mentioned earlier, samples of nurses showed that only 58% of nurses on the NY List were also on the LEIE, and only 40% of the doctors on New York’s List were on the LEIE! Regardless of the cause of these differences, they provide strong support for screening both exclusion lists.
It depends. When a State excludes or sanctions a provider, it is required to notify the OIG so that it can evaluate the facts and circumstances and decide whether a federal exclusion is also warranted. For example, an exclusion for failing to pay State taxes might be appropriate under state law, but the OIG could not impose a federal exclusion on that basis. On the other hand, a State exclusion based on a healthcare fraud conviction in State Court would clearly support a federal exclusion, and the OIG would seek a federal exclusion upon notification of the action.
Again, the answer is Maybe. States are also required to notify their sister States whenever they exclude a provider “for cause” so that they, like the OIG, can evaluate whether or not to impose an exclusion pursuant to their rules. An exclusion “for cause” is one that is based on actions that the State believes would also be the basis of a federal exclusion. The diagram below shows how the process is supposed to work.
As described by CMS in guidance to the States, the implementation of section 6501 of the ACA involves three steps: First, a State agency must communicate to its sister states about providers who have been excluded, or terminated, for cause; second, the agency must identify whether any of those providers are participating in the State’s Medicaid program; and, third, the agency must exclude or terminate the provider’s participation in its own State Medicaid program if appropriate under its rules of participation. Compliance with this regulation and guidance is sporadic among the states, but it continues to improve and get better over time.
Providers in New York have exclusion screening obligations from multiple sources, and the only way to meet them is by having a robust exclusion screening program. The best program for each provider regarding “who to screen” and “what databases to screen” will depend on a number of factors, such as the payer requirements and their relationship to claims, but providers are urged to carefully consider these questions in terms of risks and benefits.
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