Updates on Provider Requirements

January 15, 2016

Misinformation continues to be circulated about the requirements for providers to ensure that their staff and contractors are eligible to provide a Medicaid funded services.  According to the Medicaid memo of April 2009,  “all providers are required to take the following three steps to ensure Federal and State program integrity:

Screen all new and existing employees and contractors to determine whether any of them have been excluded.


Search the HHS-OIG List of Excluded Individuals and Entities (LEIE) website monthly by name for employees, contractors and/or entities to validate their eligibility for Federal programs. 


Immediately report to DMAS any exclusion information discovered.  Such information should be sent in writing and should include the individual or business name, provider identification number (if applicable), and what, if any, action has been taken to date.”


While this Memo did not get a lot of attention at the time, the requirement is one taken very seriously by CMS.  It behooves providers to ensure that they are in compliance, but with the requirements of the Memo, not with the misinformation circulated at some regional provider meetings.