Medicaid exclusion screening requirements in New York
What New York 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 New York OMIG Medicaid Exclusion List — last refreshed Oct 5, 2026, 01:32 UTC.
Updated daily at the source.List version in use: 30bfb7e4-e16f-415e-92cc-e561f9d58a25What the state requires
OMIG recommends checking at least every 30 days unless law or contract requires otherwise.
OMIG describes the 30-day interval as a best practice, not a universal statutory screening deadline. Review the law and contracts that apply to your organization. OMIG also advises checking that an ordering individual or entity has no participation restriction before filling orders or prescriptions. Search the New York list alongside the federal OIG list; a result on one does not establish the result on the other.
- OMIG explanation and disclaimers — screening recommendation
- OMIG Medicaid exclusions — official list and downloads
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
NYS Medicaid Exclusion List
New York keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
OMIG publishes individuals and entities with New York Medicaid participation restrictions under 18 NYCRR 515.3 or 515.7. It offers complete downloads and a separate list of additions in the last 30 days. The additions list cannot establish the full set of current exclusions.
- Published by
- New York State Office of the Medicaid Inspector General (OMIG)
- Refreshed
- The cited publisher pages do not state a publication interval., per the publishing agency.
How Exclia reads this list
Exclia reads the complete tab-delimited export the Office of the Medicaid Inspector General publishes, not the 30-day additions list. Names are published as one field, so they are kept exactly as written.
Every row on the complete export is treated as a current action. A name that is absent from a later complete export stops being screened; earlier versions stay in the audit trail.
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
Exclusion affects participation and payment for Medicaid services.
- During exclusion, an individual or entity may not undertake activities relating to furnishing medical care, services or supplies billed to Medicaid, or claiming or receiving Medicaid payment, as described by OMIG under 18 NYCRR 515.5.
- Claims connected to a provider with participation restrictions may be denied, and providers may have to repay payments already received.
- Reinstatement requires an application and review; an elapsed exclusion period does not automatically restore participation.
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.
OMIG states that certain terminations from Medicare, Medicaid in another state or CHIP on or after January 1, 2011 may prevent enrollment or reinstatement in New York Medicaid. Review the specific action and applicable rules before making an eligibility decision.
Common questions
Yes. OMIG publishes the NYS Medicaid Exclusion List and complete downloadable versions. It is distinct from the federal OIG LEIE.
The cited OMIG guidance calls this a recommended best practice unless otherwise required by law or contract. Your applicable legal and contractual obligations may differ.
No. The complete export contains a provider name, provider type, optional license and NPI identifiers, and an exclusion date. It does not split names or reliably classify individuals and entities. Review the official record and use OMIG’s verification process before making a decision.
No. It covers additions in the last 30 days and cannot identify every current exclusion or establish which previously listed providers have been removed.
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.