States With Separate Exclusion Databases

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States With Separate Exclusion Databases

The Center for Medicare and Medicaid Services (CMS) retains overall responsibility for the Medicaid
program, but States have final authority on who can provide services and who can receive them. States
can, for example, exclude providers for “any reason or period [of time] authorized by State law, [1] or for
any reason that the Office of Inspector General (OIG) could impose an exclusion under federal law.[2]
Since Medicaid, like Medicare, will not pay for items or services provided by an excluded party,[3] when
a State excludes or terminates a provider based on federal law, they are required to notify the OIG and
their sister States so that they can add them to their respective exclusion lists.[4] Although it is not
required, most States maintain separate lists that include the sanctions they impose.

The focus of this article is to help providers identify which States with separate sanction lists, how they
are different from the federal exclusion lists, and that affects screening.

I. Which States Maintain Medicaid Exclusion Databases?

Forty-three States and the District of Columbia maintain Medicaid sanction lists though the names of
the sanctions, and lists themselves can vary. For example, common names for State sanction lists
include: Excluded Provider List; Sanctioned Provider Report or List; Terminated Provider List. These
states are in Red in the map and Readers can access the State Exclusion Lists through the links below.

The seven states that don’t: New Mexico, Oklahoma, Rhode Island, South Dakota, Utah and
Wisconsin. For informational purposes. Links to the Medicaid websites tor the States are also found
below.

II. Why Do States Maintain Separate Lists?

States only required to notify the OIG when they exclude or terminate a party based on Federal law.
They aren’t required (or supposed) to notify it for actions based on State law because if the sanction
failed to meet the criteria for a federal exclusion, it would not be posted on the LEIE. Without a
separate State sanction list, providers would have no way of knowing if a person or entity had been
excluded or terminated. Also, even if the OIG disagrees with a State action based on federal grounds,
by maintaining their own list, the State exclusion will stand even if a federal exclusion is not imposed.

In addition to being the only way to publish State sanctions, State Lists the fastest and most efficient
way of publishing and imposing sanctions based on federal law. After a State notifies the OIG, it can
still take several months for the OIG to process the State sanction and to determine if they will also
impose an exclusion. During this lag time, the State will be able to enforce the payment prohibition
even those federal payments made still be made to the party they sanctioned!

States also may choose to maintain their own list to have a central registry for State sanctions; one that
includes non-healthcare actions in addition to exclusions or terminations. For example, federal
exclusions can be imposed for the failure to repay federal loans, and it would be reasonable for a State
to have a similar exclusion basis. Similarly, a State might want also want to exclude a party for failing
to pay State taxes, or for failing to provide a variety of other reasons, that would not be valid bases for
federal exclusions.

III. Why Don’t all States Maintain Separate Exclusion Lists?

States aren’t required to maintain their own separate exclusion list. States can, instead, treat the OIG’s
List of Excluded Individuals and Entities as their “own” list, and seven states have elected to do this.

Providers should be aware, however, that the States without separate sanction lists focused on
healthcare, may have other sanction lists that they are required to screen in addition to the LEIE. The
State agency responsible for contracting may, for example, have a separate debarment list; the agency
responsible for providing services to those in need of care may maintain a list of persons who may not
participate, the State Department of Health might have a list, and so on.

IV. How are the State Lists Different from the OIG’s Exclusion List?

The principal difference is that State lists don’t exclusively contain healthcare sanctions. They are
often used as a centralized list for several sanctions, each of which may have a different impact. State
lists are also not uniformly maintained or updated, or even found in the same location State by State.

V. Do All State Lists Have the Same Data? Are they in the Same Format? Is Verification the Same?

NO, NO and NO. Some State lists are in excel format, others and in WORD and yet others are in
PDF! They also vary widely in the data they contain and in the way the data is presented. For instance,
some State lists have little more than a name, exclusion date and address. Verification of a State
exclusion is also governed on a State by State basis.

VI. How Can Providers Meet Their State Screening Obligations?

State Exclusion are extremely difficult, if not virtually impossible, for providers to screen.
There is no uniform format, the data itself may be sparse, and verification is often time
consuming and difficult. With its proprietary State and Federal Exclusion Registry (SAFER),
Exclusion Screening, LLC imports the most recent exclusion data from each state list
constantly, and once a provider sends us its list to screen, we do all the work and providers
can sit back and wait for their report!

For additional information visit “OIG Exclusion and State Exclusion Lists: Which Exclusion Lists Need to Be Screened? What Is the Difference Between Them?”

The states that currently maintain a separate excluded provider list are the following ones below, click on a state to learn more about its screening requirements:

AlabamaIllinoisMissouriSouth Carolina
AlaskaIndianaMontanaTennessee
ArizonaIowaNebraskaTexas
ArkansasKansasNevadaVermont
CaliforniaKentuckyNew HampshireWashington
ColoradoLouisianaNew JerseyWashington DC
ConnecticutMaineNew YorkWest Virginia
DelawareMarylandNorth CarolinaWyoming
FloridaMassachusettsNorth Dakota
GeorgiaMichiganOhio
HawaiiMinnesotaOregon
IdahoMississippiPennsylvania

VII.  A Simple and Affordable Solution

Without a doubt, state and federal exclusion screening requirements are incredibly burdensome for most providers. If screening your employees against each federal and state list that your state requires is not cost effective for your office to do in-house, contact Exclusion Screening, LLC today at 1-800-294-0952 or fill out our online service form found below. We would be happy to discuss your specific state obligations, provide a cost assessment, and help you create your employee and vendor list.


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Paul Weidenfeld is a former federal healthcare fraud prosecutor and Department of Justice National Health Care Fraud Coordinator. His principal area of practice is healthcare fraud and abuse and the Federal False Claims Act, and he has represented providers and individuals in healthcare matters since leaving government in 2006. Mr. Weidenfeld also has an extensive litigation background that includes numerous trials and appeals and appearances before the United States Supreme Court, the Federal 5th Circuit Court of Appeals, and the Louisiana Supreme Court.


[1]42 CFR § 1002.3(b). 

[2]42 CFR § 1002.1(a)(4). The OIG has been delegated the authority to impose exclusions and civil money penalties under section 1128A of the Social Security Act. 81 FR 88356, Dec. 7, 2016. See also, 1003.150. 

[3]Sections 1902(a)(39) and 1903(i)(2) of the SSA; See also, 42 CFR§1002.1(a)(5).

[4]States must notify the OIG of exclusions based on federal law for inclusion to the List of Excluded Individuals and Entities (LEIE). 42 CFR § 1002.1(a)(3). The obligation to notify other states is found in the Affordable Care Act so that they, too, can determine whether it is appropriate to add the entity to their respective sanction lists. 

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