Medicaid exclusion screening requirements in Connecticut
What Connecticut 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 Connecticut DSS Administrative Actions List — last refreshed Oct 16, 2026, 09:02 UTC.
Updated monthly at the source.List version in use: 9f9edc6a-d8ba-4349-8862-9bea33b464c7What the state requires
DSS publishes the list but does not state how often to check it.
The DSS page sets no screening interval. Consult your Connecticut Medical Assistance Program provider agreement 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
Quality Assurance Administrative Actions List
Connecticut keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
A table of Medicaid providers and their businesses under a DSS suspension, exclusion or termination, with the specialty, address, effective date, the period of the action (“Indefinite” or a number of years) and the action itself. It is embedded on the DSS Quality Assurance page.
- Published by
- Connecticut Department of Social Services (DSS), Quality Assurance
- Refreshed
- Not stated by DSS; the list carries no edition date, per the publishing agency.
How Exclia reads this list
Exclia reads the Administrative Actions List table from the DSS list page.
An action whose published period had ended when the list was saved is kept as evidence but never shown as a match, because the list does not say whether the provider was reinstated. Every other row can produce a potential match.
Whether this source is screening today, and the exact file version in use, is shown on the coverage page.
What happens if it is not done
Connecticut law ties these actions to participation in the Medicaid program and to reimbursement.
- A vendor convicted of a crime involving fraud in Medicare or Medicaid is terminated from the programs, effective upon conviction, unless the Commissioner delays termination to protect beneficiaries (Conn. Gen. Stat. § 17b-99(a)).
- No vendor is eligible for reimbursement for goods or services performed by a person convicted of a crime involving fraud in those programs (§ 17b-99(a)).
- A vendor ineligible for federal financial participation is ineligible for the state programs as well (§ 17b-99(a)).
- The Commissioner sets administrative sanctions, including suspension from the program, by regulation (§ 17b-99).
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. DSS publishes an Administrative Actions List of Medicaid providers under a DSS suspension, exclusion or termination. It is separate from the federal OIG list and SAM.gov.
Each action is either indefinite or runs for a number of years from its effective date. The list does not say what happens when a time-limited action ends, so confirm current status with DSS before relying on an older entry.
DSS lists a provider once per business they operated, so one person can appear on several rows with the same date and action.
Exclia imports the list as retrieved on October 16, 2026 (93 rows). The list carries no NPIs, so a match rests on the name and address. A name on the list is shown as a potential match for your team to review, never as a determination.
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.