Ohio Medicaid Exclusion List & Regulatory Requirements
What is the Ohio Medicaid Provider Exclusion and Suspension List?
The Ohio Medicaid Provider Exclusion and Suspension List is a state-maintained database of individuals and entities excluded or suspended from participating in Ohio Medicaid. Healthcare providers operating in Ohio, or hiring employees licensed in Ohio, must screen this list in addition to federal exclusion lists such as the OIG LEIE and GSA/SAM. Missing a state-level exclusion can result in civil money penalties (CMPs) of up to ,947 per violation and potential False Claims Act exposure for retained overpayments. Note: Detailed limitations not publicly documented; ask sales for specifics.
Where can I access the official Ohio Medicaid exclusion list?
What are the penalties for failing to screen the Ohio Medicaid exclusion list?
Failure to screen the Ohio Medicaid exclusion list can result in civil money penalties (CMPs) of up to ,947 per violation, overpayment liability, and potential False Claims Act exposure for retained overpayments. These penalties are enforced under the same framework as federal exclusions. Note: Best fit for organizations seeking automated compliance; teams needing manual review may want to consider alternatives.
Features & Capabilities
Does Exclusion Screening include the Ohio Medicaid exclusion list in its screening services?
Yes, Exclusion Screening screens the Ohio Medicaid Provider Exclusion and Suspension List as part of its standard SAFER Plus service. This screening is performed alongside the OIG LEIE, GSA/SAM, and every other state Medicaid exclusion list. Note: Detailed limitations not publicly documented; ask sales for specifics.
What features does Exclusion Screening's SAFER™ software offer?
Exclusion Screening's proprietary SAFER™ software automates exclusion screening with 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 eliminates manual effort. Note: Best fit for organizations seeking automation; teams needing custom integrations should inquire about compatibility.
What types of screening does Exclusion Screening provide?
Exclusion Screening offers employee screening, vendor and contractor screening, and compliance hotline services. These are powered by the SAFER™ software and are designed to ensure compliance with federal and state regulations. Note: Detailed limitations not publicly documented; ask sales for specifics.
Pricing & Plans
How is Exclusion Screening's pricing determined?
Exclusion Screening's pricing is competitive and customized based on the specific monitoring lists and the volume of screenings required by the organization. This tailored approach ensures cost-effectiveness and scalability. To receive a personalized quote, fill out the form on the contact page. Note: Pricing details are not publicly listed; request a quote for specifics.
Implementation & Support
How long does it take to implement Exclusion Screening's services?
New clients can begin screening within 1 day, which is faster than many other vendors. The SAFER™ software is designed for easy integration and automation, with dedicated support from compliance specialists. Note: Best fit for organizations seeking rapid deployment; teams needing custom onboarding may want to inquire about additional support options.
Use Cases & Benefits
Who can benefit from Exclusion Screening's services?
Healthcare providers of all sizes, including small practices, large healthcare systems, compliance officers, risk managers, legal teams, and organizations with extensive vendor networks can benefit from Exclusion Screening's services. The solutions are tailored to address compliance, regulatory risks, and operational efficiency. Note: Best fit for healthcare organizations; teams outside healthcare should confirm applicability.
What business impact can customers expect from using Exclusion Screening?
Customers can expect improved compliance, reduced risk of penalties, cost savings through automation, operational efficiency, and enhanced integrity via secure reporting channels. The SAFER™ software and compliance hotline help organizations avoid legal and financial repercussions. Note: Best fit for organizations prioritizing compliance; teams needing custom reporting may want to inquire about additional features.
Industry Proof & Case Studies
Are there any case studies demonstrating the impact of exclusion screening?
Yes, Exclusion Screening provides a case study focused on the laboratory services industry. The case study discusses a Texas-based laboratory services company involved in submitting false claims and highlights the importance of thorough exclusion screening. Read the full case study here: OIG Exclusion Case Study: The Impact of a False Claims Act Judgment. Note: Only laboratory services industry is documented; for other industries, contact Exclusion Screening directly.
Technical & Compliance Details
What is an example of a state-specific Medicaid exclusion list?
An example of a state-specific Medicaid exclusion list is the Ohio Medicaid Provider Exclusion and Suspension List, maintained by the Ohio Department of Medicaid. Requirements are outlined in Ohio Administrative Code § 5160-1-17.8(c)(ii). Note: Best fit for organizations operating in Ohio; teams in other states should reference their own state lists.
New ReportScreening Failures & Their Financial Fallout — $26M in penalties and how to avoid them. Download the report →
The state of Ohio maintains the Ohio Medicaid Provider Exclusion and Suspension 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.
Ohio at a glance
Official list name
Ohio Medicaid Provider Exclusion and Suspension List
Each settlement below started with one missed exclusion check. All were preventable. Don’t let your organization become the next example.
January 2025 · Ohio · Nursing home / senior living
$243,001 — A senior living facility settled with OIG for employing an excluded individual. Read the OIG settlement →
October 2024 · Ohio · hospital / Medical center
$69,362 — A hospital settled with OIG for employing an excluded individual (self-disclosed). Read the OIG settlement →
April 2024 · Ohio · Healthcare services
$222,513 — A healthcare organization settled with OIG for employing an excluded individual (self-disclosed). Read the OIG settlement →
June 2023 · Ohio · hospital / Medical center
$124,555 — A hospital settled with OIG for employing an excluded individual (self-disclosed). Read the OIG settlement →
May 2023 · Ohio · Home health
$77,486 — A home health agency settled with OIG for employing an excluded individual. Read the OIG settlement →
January 2023 · Ohio · Home health
$43,765 — A home health agency settled with OIG for employing an excluded individual. 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.
Is the Ohio Medicaid Provider Exclusion and Suspension List the same as the OIG LEIE?
No. The OIG LEIE is the federal exclusion list covering Medicare, Medicaid, and all federal health programs. The Ohio Medicaid Provider Exclusion and Suspension List is separate and covers providers excluded or terminated from Ohio Medicaid specifically. Providers must screen both, along with GSA/SAM.
How often do I need to screen against the Ohio Medicaid Provider Exclusion and Suspension List?
Monthly, on hire and every month thereafter. CMS State Medicaid Director Letters #08-003 and #09-001 require monthly screening of every employee, contractor, and vendor that contributes to a claim — including billers, coders, and managing employees.
Do I need to screen the Ohio list if I’m not located in Ohio?
Yes — if you bill Ohio Medicaid or employ Ohio-licensed staff, the screening obligation applies. An exclusion in one state can also trigger sanctions in others under Section 6501 of the Affordable Care Act.
Federal penalties & cross-state implications
The OIG can impose civil monetary penalties of up to $24,947 per item or service that an excluded individual contributed to. Penalties stack quickly: a single excluded employee submitting claims over several months can produce six- or seven-figure exposure. Self-disclosure reduces but does not eliminate the penalty — recent settlements show organizations paying $100K-$3M+ even after voluntary reporting.
CMS requires monthly screening of employees, contractors, vendors, and any party who contributes to a claim — including billers, coders, and managing employees. Screening is required on hire and monthly thereafter (CMS State Medicaid Director Letters #08-003 and #09-001).
An exclusion in one state can trigger sanctions in others under Section 6501 of the Affordable Care Act. Providers should screen against the OIG LEIE, GSA/SAM, and every state Medicaid exclusion list — not just their home state.
