Medicaid exclusion screening requirements in West Virginia
What West Virginia 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
West Virginia’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 state publication and applicable provider requirements.
Official provider workshop material directs providers to check state and federal databases and describes the state list as updated monthly. Publication cadence does not establish one universal screening frequency for every organization. Verify the identity, action and program scope before resolving a potential match.
- WVMMIS: Medicaid provider action publication
- West Virginia Medicaid provider workshop: state and federal database checks
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
WV Medicaid Provider Exclusions and Terminations
West Virginia keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
The verified October 2026 publication contains 166 provider rows across thirteen pages, including both exclusion and termination actions and their stated reasons. It records names, NPI cells, addresses and action dates. These actions remain distinct; the list is not a universal eligibility determination.
- Published by
- West Virginia Bureau for Medical Services
- Refreshed
- Monthly publication, as described in the official provider workshop; verify the current portal file., per the publishing agency.
How Exclia reads this list
Exclia reads the monthly PDF from the Bureau for Medical Services, page by page.
Each row keeps the publisher’s own action label, so an exclusion and a termination stay distinct. Activation waits on a review of which action types count as current.
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
Review the published action and reason for the individual record.
- The publication includes state licensing actions, OIG references, other-program terminations and other reasons. A termination label is not interchangeable with a federal exclusion. An elapsed action date or an indefinite label does not prove reinstatement.
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. The publication includes firm-like names and some combined firm/person cells without an explicit entity-type field. Preserve the published name and verify identity instead of inventing an owner alias or classification.
No. Some cells contain missing values, deactivation annotations or several NPIs. Ambiguous cells remain raw evidence with no single canonical NPI chosen.
No. Coverage depends on enabled collection, reviewed terms, approved immutable activation and fresh retrieval metadata. The portal publication date is separate from an actual Exclia retrieval timestamp.
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.