Medicaid exclusion screening requirements in Massachusetts
What Massachusetts 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
Massachusetts’s own Medicaid exclusion list is rolling out to Exclia. The federal lists (OIG LEIE and SAM.gov) are screened today.
What the state requires
Consult the official MassHealth publication and verify identity and scope.
The reviewed publication does not establish a statewide screening frequency. Its effective-through date does not replace an actual Exclia retrieval or activation timestamp; a name match is not an eligibility determination.
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
Suspended/Excluded MassHealth Providers
Massachusetts keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
The complete fourteen-page publication is effective through August 31, 2026. It names providers, provider types, NPI or unique identifiers, action reasons and effective dates, with a separate final-page reinstatement table.
- Published by
- Massachusetts Executive Office of Health and Human Services — MassHealth
- Refreshed
- Not established by this dated publication., per the publishing agency.
How Exclia reads this list
Exclia reads the MassHealth list of suspended or terminated providers (PDF).
Some rows carry action codes whose current meaning the publisher does not state. Exclia stores every row as evidence but screens none of them until those meanings are confirmed.
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
MassHealth identifies this as its provider participation restriction roster.
- Published reasons include program participation requirements and licensing-board action. This state publication is separate from procurement SAM records and includes a separate reinstatement table; restored providers must not be treated as currently restricted.
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
No. NPI and Unique ID are distinct columns. An absent or invalid NPI remains unresolved identifier evidence and is not invented from another identifier.
No. Live coverage depends on enabled collection, reviewed terms, immutable approval and sufficiently recent retrieval shown by the coverage metadata. This guide is pending counsel review.
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.