U.S. Department of Health & Human Services – Office of the Inspector General, and the U.S. General Services Administration, and State Exclusion Checks
Regulators prohibit our organization from hiring, employing or making payments to any person or business excluded or debarred from federal or state health care programs. Exclusion Checks Quick Reference Guide
Medicare & Medicaid: All delegates working with our Medicare Advantage Parts C and D or Medicaid programs must review the federal exclusion lists maintained by the U.S. Department of Health & Human Services – Office of the Inspector General (HHS-OIG) and the U.S. General Services Administration (GSA). These exclusion lists name individuals or organizations that are suspended or otherwise excluded from participation in Medicare and Medicaid programs.
Frequency: Delegates must review all employees and subcontractors that support Medicare Advantage Parts C and D and/or Medicaid plans and membership against OIG and GSA federal exclusion lists prior to hiring or contracting with them, and on a monthly basis thereafter.
Federal Exclusion Checks: Find the HHS-OIG List of Excluded Individuals and Entities.
State Exclusion Checks
Many states maintain state-based sanction/exclusion databases that are in addition to, but do not replace, the OIG and GSA federal exclusion databases. A provider may not participate in the network of a specific state if the provider is listed on that state’s exclusion list, even if the provider is not listed on a federal exclusion list.
State Exclusion List Resource: Visit Verify Comply®, a vendor that offers several exclusion list search options.