Exclusion screening is the federal and state compliance obligation to verify that healthcare employees, vendors, and contractors are not barred from participating in Medicare, Medicaid, or other federally-funded programs. Every healthcare provider that bills a federal program is required to screen upon hire and monthly thereafter against the OIG LEIE, GSA/SAM, and all 44 state Medicaid exclusion lists. Failure to screen exposes providers to civil money penalties of up to $24,947 per violation, overpayment liability, and potential False Claims Act exposure. This section of the site is the definitive hub for exclusion screening compliance: the pillar guides, state-by-state requirements, enforcement trends, and the regulatory framework explained by the former federal prosecutors who built it.
Connecticut Department of Social Services maintains the Connecticut DSS Quality Assurance Administrative Actions List — a separate Medicaid…
Colorado Department of Health Care Policy and Financing maintains the Colorado HCPF Provider Termination List — a separate…
The state of Arkansas maintains the Arkansas Medicaid Exclusions — a separate Medicaid exclusion list providers must screen…
Arizona Health Care Cost Containment System (AHCCCS) maintains the Arizona AHCCCS Provider Fraud/Actions — a separate Medicaid exclusion…
The state of Alaska maintains the Alaska Excluded Provider List — a separate Medicaid exclusion list providers must…
Historical index of settlements and penalties from OIG investigations and self-disclosed violations.
The 44 state Medicaid exclusion lists — each state's program name, issuing agency, file format, and the screening obligations providers have to meet. By former DOJ Health Care Fraud Coordinator Paul Weidenfeld.
This guide is intended to assist Apple Health providers on exclusion and sanction screening obligations for anyone whose role could affect Medicaid billings or deliverables — clinical and non-clinical — and describes how to screen, document, remediate, and report matches.
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