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Ann Marie T. Sullivan, M.D., Acting Commissioner
Governor Andrew M. Cuomo

Individuals or Entities Restricted from Participation in the Medicaid Program

The Office of the Medicaid Inspector General (OMIG) reminds providers to screen employees, prospective employees and contractors, both individuals and entities, to ensure that their participation in the Medicaid program has not been restricted, terminated or excluded under the provisions of 18 NYCRR § 504.7(b) - (h), 18 NYCRR §515.3, or 18 NYCRR §515.7. 

The OMIG maintains a list of individuals or entities, on its website, whose participation in the Medicaid program has been restricted, terminated or excluded.  The OMIG also recommends that providers check this list on a monthly basis to capture exclusions and terminations that may have taken place since the previous search. 

The OMIG website allows providers to download the listing or select the “short list” option, which offers a list of all changes that have taken place over the previous 30 days.  Providers can access details, including regulatory citations and search options, at   http://www.omig.ny.gov/data/content/view/72/52/ Leaving OMH site .

Use of the list will help providers to avoid denial of claims and will help the OMIG/DOH ensure that claims for medical care, services and /or supplies are ordered or prescribed by individuals permitted to order or prescribe under the Medicaid program.

In addition to the OMIG’s website, providers may also utilize the website maintained by the Inspector General of the U.S. Department of Health and Human Services (DHHS) to screen individuals/entities to determine if they are excluded from participation in Federal health care programs.  The DHHS’s website can be accessed at http://oig.hhs.gov/fraud/exclusions.asp Leaving OMH site .