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Excluded Provider Lists

Posted: 07-20-2017

The federal Health and Human Services–Office of Inspector General (OIG) has the authority to exclude individuals and entities from participation in Medicare, Medicaid and other federal health care programs. MHCP also excludes individuals and entities from participation in MHCP if they are on either the federal or state excluded provider list.

Follow these links to access the lists:

  • Office of Inspector General (OIG) Exclusions Database
  • MHCP Excluded Group Providers
  • MHCP Excluded Individual Providers
  • Also see MHCP Provider Screening Requirements.

    Federal Exclusions List
    Minnesota Excluded Providers

    Checking Exclusion Lists

    Reporting

    MHCP Recovery of Funds Paid to Excluded Providers

    Removal from Lists

    Federal Exclusions List

    The Office of Inspector General (OIG) provides information to the health care industry, patients and the public about individuals and entities who are currently excluded from participation in Medicare, Medicaid and all other federal health care programs. The OIG publishes a list of excluded providers and may impose civil monetary penalties against providers who employ or enter into contracts with excluded individuals or entities to provide services or items to MHCP members.

    Providers who choose to enroll with MHCP must check all owners, managing employees, board members, employees or anyone else who works for the provider in any capacity against the Office of Inspector General exclusions database. The exclusions database provides information to the health care industry, patients and the public about individuals and entities currently excluded.

    When an individual or entity is excluded, no payment will be made by any federal health care program for any items or services furnished, ordered or prescribed by the excluded individual or entity. This payment withholding applies to the excluded person and anyone who employs or contracts with the excluded person. The exclusion applies regardless of who submits the claims and applies to all administrative and management services furnished by the excluded person.

    Minnesota Excluded Providers

    MHCP maintains and publishes lists of all individual or group providers suspended or terminated from receiving payment from Medicaid funds who MHCP has excluded. These lists are in addition to the federal exclusions list.

    Besides checking the LEIE, you should also check the Minnesota excluded provider lists when you employ or enter into contracts with individuals or entities to provide services or items to MHCP members to ensure you allow only those who are qualified provide services and receive reimbursement. Anyone who is on the list is excluded from employment with an entity to provide services to members for whom you will submit claims to MHCP for reimbursement to. MHCP willdeny claims for services or items rendered, ordered, referred or prescribed by excluded providers.

    Owner information is not included on the individual provider list unless the owner is also enrolled as an individual provider of services.

    For individual providers, the list shows the following:

  • • Provider type description
  • • Last name, first name, middle name
  • • Effective date of exclusion
  • • Address line 1 (This is the last known practice, organization or provider where the person was working)
  • • Address line 2
  • • City
  • • State
  • • ZIP code
  • For group or organization providers, the list shows:

  • • Provider type description
  • • Agency name
  • • Effective date of exclusion
  • • Address line 1
  • • Address line 2
  • • City
  • • State
  • • ZIP code
  • MHCP updates excluded provider lists monthly.

    Checking the exclusion lists

    As enrolling or enrolled MHCP providers, you must make sure you, your company, owners, managers, employees and contractors are not on an excluded provider list. Search List of Excluded Individuals/Entities LEIE and the Minnesota excluded group and individual providers lists by the individual’s or entity’s name:

  • • Before hiring or entering into contracts with individuals or entities to provide services or items to MHCP members.
  • • Ongoing (at least monthly) to check for changes since your last search.
  • Keep verifications for your own records of anyone on an exclusion list.

    Verifying information

    To verify information that may not be clear on the list, such as a person with a similar name, or a person with the same name but the list shows as a different provider type, call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411. The call center representative will request identifying data, including but not limited to the tax ID number (EIN or FEIN), Social Security number (SSN) or date of birth. MHCP uses this information to confirm whether the person you are calling about matches the person displayed on the excluded providers list. The call center representative will only verify whether the information you provide matches the identifying information.

    Reporting

    Report any new exclusions you find in your search to MHCP Provider Enrollment. Fax information, including a cover sheet, to 651-431-7462. MHCP will also verify the entity and individuals listed against the LEIE on an ongoing basis to identify and remove anyone added to the federal list of exclusions.

    Placement on an exclusion list

    Providers named on the excluded providers list have been terminated due to fraud, theft, abuse, error or noncompliance in connection with a Minnesota health care program. Providers are notified that they are being terminated before they are named on the published list. They are not eligible for payment from MHCP effective the date of the notification. Excluded providers are not prohibited from providing services for private-pay clients.

    MHCP recovery of funds paid to excluded providers

    MHCP will not pay for services that providers or individual staff members provide to MHCP recipients after they have been terminated. If MHCP has already paid for services and then finds that a provider on an exclusion list performed the service, we may recover all funds paid.

    Removal from lists

    Individuals and entities who have been reinstated will no longer be on the OIG list.

    A provider who is on the MHCP list must go to the Surveillance and Integrity Review Section (SIRS) to request removal from the list. This information is in the letter sent from SIRS when the provider was first added to the list. SIRS will notify MHCP provider enrollment directly when a determination is made to remove an entity from either of the MHCP exclusion lists.

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