Medicaid exclusion screening requirements in Arizona
What Arizona Medicaid requires of the organizations that take part in it: whether the state keeps its own exclusion list, how often it expects you to check, what the penalties are, and how an action taken in another state reaches you here. Every claim on this page links to the source it came from.
What Exclia screens for this state
Exclia screens Arizona AHCCCS Provider Suspensions and Terminations — last refreshed Oct 15, 2026, 14:23 UTC.
Updated monthly at the source.List version in use: 17cf5144-f8b7-4c2e-a0bc-03fdd667b8d3What the state requires
AHCCCS publishes both lists but does not state how often to check them.
Neither the Provider Suspensions and Terminations page nor the State Exclusion List page sets a screening frequency. Consult your AHCCCS Provider Participation Agreement, program rules and contracts for any interval that applies to you; federal guidance on monthly checks of the OIG list applies regardless.
Why monthly, and where the exposure comes from
The HHS Office of Inspector General publishes the federal exclusion list (the LEIE) monthly, and its guidance to providers is that screening staff and contractors each month is what best limits the risk of overpayment and civil monetary penalty liability. State Medicaid agencies are themselves required to check the LEIE no less frequently than monthly (42 C.F.R. § 455.436(c)(2)), which is the rhythm the lists move on.
The state’s own list
Provider Active Suspensions (Provider Suspensions and Terminations)
Arizona keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
AHCCCS publishes a PDF of providers whose payments are suspended under a credible allegation of fraud, from federal fiscal year 2020 to the present, and removes a name when the suspension is lifted. It also publishes a separate State Exclusion List recording the exclusion actions it has taken under A.A.C. R9-22-1802.
- Published by
- Arizona Health Care Cost Containment System (AHCCCS), Office of Inspector General
- Refreshed
- Not stated by AHCCCS; each edition is dated (“Updated 09/02/2026”), per the publishing agency.
What happens if it is not done
Arizona law defines exclusion in terms of payment: items and services furnished, ordered or prescribed by a provider under an exclusion are not reimbursed.
- Under A.R.S. § 36-2930.05(E), “exclude” means that items and services furnished, ordered or prescribed by the provider will not be reimbursed by AHCCCS, a contractor or their agents, and includes terminating or refusing a provider agreement.
- AHCCCS may suspend payments when it identifies a credible allegation of fraud (42 CFR 455.23). A suspension rests on preliminary findings, not a determination, and is lifted if AHCCCS finds no fraud or good cause under the same rule.
- AHCCCS may terminate a provider for reasons including lack of licensure, quality-of-care concerns and failure to disclose required information, and reports terminations for fraud, integrity or quality reasons (42 CFR 455.416).
- Reinstatement after an exclusion is not automatic: the provider applies after the exclusion ends (A.A.C. R9-22-1805), and a rescinded exclusion is removed from the list.
- A.R.S. § 36-2930.05 — Provider participation; grounds for exclusion; rules; definition
- 42 CFR 455.23 — Suspension of payments in cases of fraud
- State Exclusion List — AHCCCS
The federal exposure behind the state requirement
Where a federal health care program pays for an item or service furnished, ordered, or prescribed by a person on an exclusion list, the OIG can seek repayment of what was paid, civil monetary penalties for each item or service claimed (a statutory $10,000, adjusted annually for inflation), and an assessment of up to three times the amount claimed. The standard is what the organization knew or should have known — which is why the date of your last check is the fact that matters.
How another state’s action reaches you here
Section 6501 of the Affordable Care Act (42 U.S.C. § 1396a(a)(39), implemented at 42 C.F.R. § 455.416(c)) requires a state Medicaid agency to deny or end the enrollment of any provider that was terminated for cause on or after January 1, 2011 under Medicare, or under the Medicaid or CHIP program of any other state, and that appears in the federal termination database. In practice that means an action taken against a provider in one state reaches their participation in every other — so the list that matters to you is not only your own state's.
Common questions
Yes. AHCCCS publishes a State Exclusion List of exclusion actions taken under A.A.C. R9-22-1802, with each exclusion’s effective and end dates. It also publishes a separate list of active payment suspensions.
A payment suspension is applied while a credible allegation of fraud is investigated and is lifted if the allegation is not borne out. An exclusion means AHCCCS will not pay for items or services the provider furnishes, orders or prescribes. Neither is a finding about a particular person until confirmed with AHCCCS.
AHCCCS removes the provider’s name from the suspension list, so the list shows suspensions currently in force. A rescinded exclusion is likewise removed from the State Exclusion List, and an exclusion that ends after a successful reinstatement application is end-dated.
Yes. Providers have due process rights beginning with a state fair hearing, set out in the notice AHCCCS sends when it suspends, terminates or excludes them.
Both. Exclia imports the State Exclusion List effective October 16, 2026 (803 rows) and the suspension list dated September 2, 2026 (211 rows), both parsed on October 15, 2026. A name on either list is shown as a potential match for your team to review, never as a determination. Many entries for individuals carry no NPI, because AHCCCS withholds their identifiers.
Check one name against the federal lists, free
One name, no account, and the result states which sources it covered and which it did not. It is a spot check rather than monitoring — it does not satisfy a monthly requirement on its own.
Run a free checkOr do it for everyone you monitor, every month
Exclia screens every person and vendor you monitor each month against the sources we cover, and keeps the dated audit trail that shows you did it.
See pricingEvery published state in one printable table, with the source for each row and a publication date you can check. Get the state-by-state requirements table
This states what each state publishes and links to where it says it. It is not legal advice, and where your own obligations are unclear your counsel is the right reader of these sources.