Glossary
Medicaid exclusion
A Medicaid exclusion bars a person or organization from a state’s Medicaid program. It can come from OIG, which covers every state, or from the state Medicaid agency itself, which publishes its own list.
What to know
- States can exclude or terminate providers under their own authority. Federal rules require a state to terminate a provider that Medicare or another state has terminated for cause.
- State Medicaid agencies must check the LEIE and SAM.gov for their enrolled providers when they enroll and at least monthly afterwards.
- Each state publishes its own list, in its own format and on its own schedule, so an organization working in several states checks each state’s list as well as the federal ones.
Official sources
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Related terms
Check names against every list at once
Exclia checks your employees, contractors and vendors against federal and state lists, keeps a dated record of every check, and flags potential matches for your review.