Medicaid Enforcement

A Provider’s Guide to the Pennsylvania Precluded Provider List

The Pennsylvania Precluded Provider List, commonly referred to as “Medicheck,” identifies individuals and entities who have been excluded from participating…

An Overview of the Medi-Cal Suspended and Ineligible Provider List

Most healthcare providers and suppliers in the State of California are aware that exclusions imposed by the Department of Health…

Why Should We Screen Against the Social Security Administration Death Master File?

At Exclusion Screening, we often receive questions about the scope and frequency of an organization’s screening duties and responsibilities. One…

North Carolina Exclusion Screening Requirements

To understand the North Carolina Exclusion Screening Requirements, we must first touch upon Exclusions in general. Office of Inspector General…

Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B) — The Collateral Consequences of a State Medicaid Enrollment Termination Action

Exclusion Actions Under 42 U.S.C. § 1320a-7(b)(5)(B)  (November 2020):  Since 1976, the Department of Health and Human Services (HHS), Office…

Massachusetts Medicaid Exclusion Screening Requirements

Massachusetts Medicaid Exclusion Screening: Requirements and Best Practices for Compliance The Massachusetts Medicaid Exclusion requirements, under MassHealth, will not reimburse…

Pennsylvania Doctor Excluded in Connection with Quality of Care

Over the past year, both State and Federal law enforcement investigators and prosecutors have gone to considerable lengths to publicize…

States With Separate Exclusion Databases

The Center for Medicare and Medicaid Services (CMS) retains overall responsibility for the Medicaidprogram, but States have final authority on…

Alabama Exclusion Screening Requirements

(May 2, 2019) The Alabama Medicaid Program imposes significant exclusion screening requirements on its providers.  Many are unaware of the extent…

California Exclusion List Screening Requirements

What are the California Exclusion List Screening requirements?  The Medi-Cal Program will not pay for any item or service furnished…