Current States With Separate Exclusion Databases



I. Medicaid Exclusion

Exclusion Screening, LLC conducts monthly checks of our clients’ employees, contractors, and vendors against the OIG-LEIE, GSA-SAM, and all available State Exclusion Lists. Most providers understand that they have an obligation to check their employees, contractors, and vendors against the OIG-LEIE prior to hiring and monthly thereafter. Fewer providers are aware of their obligation to screen their individual state exclusion list, if their state maintains such a list.

CMS directed state Medicaid Directors to remind all providers that they have an obligation to search their state list whenever they search the LEIE.[1] In addition, many states require providers when they enroll or re-enroll in the Medicaid program to certify that no employee or contractor is excluded from participation in any state. This requirement echoes the Affordable Care Act (ACA) Section 6501, which states that if a provider is excluded in one state, he or she is excluded in all fifty states.[2]

II.  SAFERTM 

Exclusion Screening, LLC’s proprietary database, SAFER (State and Federal Exclusion Registry), imports the most recent exclusion data from each state list constantly. We are also in regular contact with state Medicaid and Program Integrity Offices about their lists.

III. State Exclusion Lists

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: 

AlabamaIdahoMichiganNorth Carolina
AlaskaIllinoisMinnesotaNorth Dakota
ArizonaIndianaMississippiOhio
ArkansasIowaMissouriPennsylvania
CaliforniaKansasMontanaSouth Carolina
ColoradoKentuckyNebraskaTennessee
ConnecticutLouisianaNevadaTexas
FloridaMaineNew HampshireWashington
GeorgiaMarylandNew JerseyWashington DC
HawaiiMassachusettsNew YorkWest VirginiaWyoming

IV.  Some States Require Screening Extraneous Lists

In addition to these states’ excluded provider lists, many states also require providers to check other various Medicaid Exclusion databases. In Ohio, for example, providers must search the Ohio Department of Developmental Disabilities Abuser Registry, the Ohio Auditor of State – Finding for Recovery Database, Ohio Department of Developmental Disabilities Abuser Registry, Social Security Administration’s Death Master File, The National Plan and Provider Enumeration System, in addition to the LEIE, SAM, and Ohio Exclusion List.[3] New Jersey providers must check the LEIE, New Jersey Division of Consumer Affairs licensure databases, New Jersey Department of Health and Senior Services licensure database, and the certified nurse aide and personal care assistant registry on a monthly basis.[4] 

For additional information visit “OIG Exclusion and State Exclusion Lists: Which Exclusion Lists Need to Be Screened? What Is the Difference Between Them?”
V.  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. We would be happy to discuss your specific state obligations, provide a cost assessment, and help you create your employee and vendor list.

Medicaid oig Exclusion

Ashley Hudson, Associate Attorney at Liles Parker, LLP and former Chief Operating Officer for Exclusion Screening, LLC, is the author of this article.


[1] See Letter from Centers for Medicare and Medicaid Services (CMS) to State Medicaid Directors 5 (Jan. 16, 2009).

[2] See 42 U.S.C. § 1396a(a)(39) (2012), available at http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf (codifying the termination requirements of ACA § 6501); see also Letter from Centers for Medicare and Medicaid Services (CMS), CPI-CMS Informational Bulletin, Affordable Care Act Program Integrity Provisions – Guidance to States — Section 6501 – Termination of Provider Participation under Medicaid if Terminated under Medicare or other State Plan (Jan. 20, 2012), available at http://downloads.cms.gov/cmsgov/archived-downloads/CMCSBulletins/downloads/6501-Term.pdf.

[3] See Ohio Admin. Code § 5160-1-17.8(c)(ii); Ohio Medicaid Provider Exclusion and Suspension List, Ohio Dep’t of Medicaid, http://medicaid.ohio.gov/PROVIDERS/EnrollmentandSupport/ProviderExclusionandSuspensionList.aspx (last accessed Jan. 22, 2015).

[4] Newsletter to All Providers, from the New Jersey Dep’t of Human Servs., et al., Excluded, Unlicensed or Uncertified Individuals or Entities (Oct. 2010).

Unlocking the GSA-SAM Mystery

server room GSA-SAM SAM Exclusion Search

I. SAM Exclusion Search

We talk fairly infrequently about the General Service’s Administration’s System for Award Management (GSA-SAM) and about SAM Exclusion Search and thought it was time to address that lapse in information!

We know that the Office of the Inspector General has authority to exclude individuals under Section 1128 of the Social Security Act. It is also true that many individuals who appear on the SAM were originally listed on the Excluded Parties List System (EPLS). In addition, the SAM includes information from the Central Contractor Registration System (CCR) and the Online Representations and Certifications Application (ORCA). Now that these lists have merged, we wondered where the SAM was getting its updated exclusion information from.

II. The Agencies Reporting Exclusions to the GSA-SAM

If you have reviewed the SAM, you may have noticed that different agencies are listed along with excluded individuals. As of April 21, 2015, 68 federal agencies were reporting exclusions to SAM including the Department of Health and Human Services (HHS), the Department of Justice (DOJ), Veteran’s Affairs (VA), and the Department of Agriculture (USDA).

One of our favorite activities is getting into the weeds of an exclusion database, so our experts took a closer look at the agencies that were reporting to SAM. We discovered that over half of the total exclusions reported to SAM come from HHS. This was expected because we often find that if a name matches a person on the LEIE it also matches a person on the SAM. The next largest contributors were: the Office of Personnel Management (OPM) (26.6%); the Department of the Treasury Office of Foreign Assets Control (TREAS-OFAC) (6.2%); the Department of Justice (DOJ) (5.2%); and the Department of Agriculture Office of Food and Nutrition Services (USA-FNS) (3.1%).

Because OPM is the next largest reporting agency, we looked into who is excluded under its authority. OPM is also excludes health care providers. Specifically, it is debars them from participation in the Federal Employees Health Benefits Program (FEHBP). This means that 77.4% of the persons excluded on the SAM are excluded from participating from some health care industry component.

III.  Final Thoughts

This discovery supports our belief that it is critical to screen the SAM in addition to the LEIE.  OPM excludes from FEHBP individuals who have lost a professional license, been convicted of a crime related to the delivery of or payment for health care services, violated provisions of a Federal program, or been debarred by another Federal agency. These reasons mirror some of the reasons individual and entities are excluded from participation in the Federal health care programs by OIG and State Medicaid offices. It is likely that individuals excluded by OPM will also be excluded by the OIG, but there is no way to know how often information passes between these agencies or between licensing boards and the agencies. 

In our opinion, best practices include screening the SAM and the LEIE monthly, in addition to all available state lists, to ensure that your office is protected and potentially knows about an excluded individual before the OIG. Exclusion Screening, LLCSM conducts a comprehensive search of all available databases each month for its clients. For a free consultation, please call 1-800-294-0952 or fill out our assessment of needs and costs.

Ashley Hudson SAM Exclusion Search

Ashley Hudson, Associate Attorney at Liles Parker, LLP and former Chief Operating Officer for Exclusion Screening, LLC, is the author of this article. Contact the exclusion experts at Exclusion Screening, LLCSM today for a free consultation by calling 1-800-294-0952 or online.

2014 In Review – OIG Crack Down on Exclusion Violations

OIG Exclusion Violations

I.  CMPs doubled in OIG Exclusion Violations 2014

Exclusion Screening, LLCSM dedicates a significant amount of time to examining the Office of the Inspector General’s (OIG) enforcement actions as they relate to exclusion violations. As a broad overview, in 2014 HHS-OIG imposed $10.54 million in Civil Monetary Penalties (CMPs) on providers that “knew or should have known” one or more of their employees or vendors was excluded from participation in the Federal health care programs. Most noteworthy, this number more than triples the $3.26 million in CMPs collected in 2013 and is the highest amount collected in the last five years.

In 2014, the OIG cracked down on many different types of providers. The OIG’s focus varied from pediatricians to large hospitals to home health organizations. However, the OIG specifically targeted nursing homes, which totaled a quarter of all exclusion enforcement actions in 2014. While nursing homes were also the most highly targeted industry in 2013, the OIG doubled the number of enforcement actions against nursing homes for exclusion violations in 2014.

II.  2015 Likely to See Increase in OIG Enforcement Action

Do these higher CMP amounts and increased enforcement actions mean there were simply more bad actors in 2014 than 2013? Likely no. These increases indicate that the OIG has identified an area ripe with exclusion violations and chose to target this sector. In fact, in its 2015 Work Plan, the OIG specifically mentions that fraud is prevalent in home health agencies and pledged to determine the extent to which home health agencies are employing individuals with “potentially disqualifying” criminal convictions. 

Are specific areas of the United States more vulnerable than others for exclusion related violations? No. In fact, the OIG enforcement actions are not localized to one particular state or geographic area. The 60 exclusion enforcement actions in 2014 spanned 32 states. Texas took the lead with 6, and California followed closely with 5. Utah, North Carolina, and Ohio each had 4 enforcement actions. Furthermore, smaller states like Vermont and Iowa were not far behind with 3 and 2 enforcement actions.

III.  Monthly OIG Exclusion Screening Is Essential

From this data, we can conclude that no matter the size, location, or industry, providers and health care organizations must be checking all their employees and vendors for exclusions against the LEIE, SAM, and state lists monthly. The OIG is not slowing down enforcement of exclusion violations. The OIG posted its first exclusion action of 2015 with a CMP collection of $431,041.28 for one excluded employee. Conducting proper screening may seem burdensome, but Exclusion Screening, LLCSM can help your practice comply with state and federal exclusion screening obligations at a low, fixed price. Contact us for a free consultation at 1-800-294-0952 or fill out our online service form today.

Also read more on OIG Exclusion

OIG Exclusion Violations 2014

Ashley Hudson, Associate Attorney at Liles Parker, LLP and former Chief Operating Officer for Exclusion Screening, LLC, is the author of this article.