Medicaid exclusion screening requirements in Missouri
What Missouri 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 Missouri MMAC Sanction List — last refreshed Oct 15, 2026, 14:25 UTC.
Updated monthly at the source.List version in use: 12179df6-1689-42a4-9108-172e84f83ebbWhat the state requires
MMAC tells providers to check its sanction list at least monthly.
MMAC reminds providers that an effective compliance program should include checking the sanction list at least monthly, so that any termination since the last search is caught. The monthly check is MMAC’s guidance on its Provider Sanctions page rather than a regulation. Separately, because federal rules require anyone who orders or refers Medicaid services to be enrolled, MMAC asks enrolled providers to confirm that an orderer or prescriber has not been terminated before filling an order or prescription.
- Provider Sanctions — Missouri Medicaid Audit and Compliance
- 42 CFR 455.410 — Enrollment and screening of providers (ordering and referring)
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
MMAC Sanction List (List of Terminations)
Missouri keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
MMAC’s list of providers whose enrollment in the Missouri Medicaid program has been terminated since February 3, 2011, with the reason for each termination. MMAC notes that not every terminated provider is on it: the list holds terminations for conduct deemed potentially detrimental to the program.
- Published by
- Missouri Department of Social Services, Missouri Medicaid Audit and Compliance (MMAC)
- Refreshed
- Reviewed monthly for updates, per MMAC, per the publishing agency.
What happens if it is not done
Missouri states the consequence in terms of claims: care linked to a terminated provider should not be billed to Medicaid, and the provider who bills can be asked to repay.
- A terminated provider may not furnish, order, prescribe or refer services for which a Missouri Medicaid claim will be made.
- A claim for care, services or supplies ordered or prescribed by a provider on the list may be denied, and the enrolled provider who filled the order or prescription may be held responsible for repaying what Medicaid paid.
- A prior approval or authorization is not a guarantee of payment when the orderer turns out to be terminated.
- MMAC imposes terminations, and other sanctions from education to payment suspension, under 13 CSR 70-3.030, weighing aggravating and mitigating circumstances.
- Provider Sanctions — Missouri Medicaid Audit and Compliance
- 13 CSR 70-3.030 — Administrative actions for improperly paid, false, or fraudulent claims for MO HealthNet services
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.
A provider terminated on or after January 1, 2011 by Medicare, or by the Medicaid program or CHIP of any other state, may not be enrolled or reinstated in Missouri Medicaid (42 CFR 455.416(c)) — so another state’s termination can matter here even when the provider is not on Missouri’s own list.
Common questions
Yes. Missouri Medicaid Audit and Compliance publishes a workbook of providers whose Missouri Medicaid enrollment has been terminated since February 3, 2011, with the termination date, provider type and reason. It is separate from the federal OIG list and SAM.gov.
At least monthly, according to MMAC’s guidance for an effective compliance program. MMAC also reviews the list monthly for updates.
Federal rules require ordering and referring providers to be enrolled, so a terminated provider may not order, prescribe or refer Medicaid services. MMAC asks pharmacies and other providers who fill orders to check that the orderer has not been terminated; otherwise the claim may be denied and the payment recovered.
No. MMAC states that not every provider whose enrollment was terminated since February 3, 2011 is listed; the list holds providers it terminated for conduct deemed potentially detrimental to the program. Confirm status with MMAC when a result matters.
Exclia imports the list updated through September 2026 (280 rows), parsed on October 15, 2026. 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.