Medicaid exclusion screening requirements in Kentucky
What Kentucky 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.
Content review and source verification
- Last reviewed
- Last verified
- Content owner
- Exclia content team
- Review cadence
- Every 90 days
- Next review due
What Exclia screens for this state
Exclia does not yet screen Kentucky’s own Medicaid exclusion list. We screen the federal lists, and we publish every source we do and do not cover rather than leaving you to assume.
What the state requires
Kentucky writes the monthly search into the participation regulation itself.
Under Kentucky’s Medicaid participation regulation, a provider participating in — or applying to participate in — the program searches the federal OIG exclusion list (the LEIE) and the System for Award Management every month, to determine whether any current employee or contractor has been removed from the Kentucky program or from Medicare or Medicaid nationally. Because the obligation is in the regulation rather than in guidance, it is a condition of participation rather than a recommendation.
- 907 KAR 1:672 — Provider enrollment, disclosure, and documentation for Medicaid participation
- 907 KAR 1:671 — Conditions of Medicaid provider participation; withholding overpayments, administrative appeal process, and sanctions
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
Terminated and Excluded Provider List
Kentucky keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
The state’s list of providers whose Kentucky Medicaid participation has ended or been withdrawn. A provider on it is not reimbursed for services provided in any capacity or any category under Kentucky Medicaid.
- Published by
- Kentucky Cabinet for Health and Family Services, Department for Medicaid Services
- Refreshed
- Updated monthly, per the publishing agency.
What happens if it is not done
Kentucky’s consequence is stated as a reimbursement rule, and it is broad on purpose: it covers any capacity, not only billing providers.
- A provider on the state list is not reimbursed for services provided in any capacity or in any category under Kentucky Medicaid — which means an organization that bills for work involving that person carries the cost.
- A person or entity on the federal OIG list is likewise not reimbursed for Kentucky Medicaid services in any capacity, whether or not they also appear on the state list.
- The federal exposure applies on top: repayment of what was paid, civil monetary penalties for each item or service claimed, and an assessment of up to three times the amount claimed.
- Terminated and Excluded Provider List — Cabinet for Health and Family Services
- HHS Office of Inspector General, Special Advisory Bulletin on the Effect of Exclusion (May 8, 2013)
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.
Kentucky’s regulation asks about national status as well as its own: the monthly search covers whether a person has been removed from Medicare or Medicaid anywhere, not only from the Kentucky program.
Common questions
Yes. The Department for Medicaid Services publishes a list of providers whose participation has ended or been withdrawn, and updates it monthly. It is separate from the federal OIG list.
Monthly, and the requirement is in the participation regulation rather than in guidance: a participating provider searches the federal LEIE and the System for Award Management every month for current employees and contractors.
Yes. The regulation names existing employees and contractors, so the monthly search covers both.
Kentucky Medicaid does not reimburse for services provided in any capacity by a person on the list, and the federal exposure — repayment, penalties per item claimed, and an assessment of up to three times the amount claimed — applies on top of that.
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 the whole roster, every month
Exclia screens every person and vendor on your roster 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.