Excluded Provider Lists

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The Minnesota Department of Human Services (DHS) maintains Excluded Provider Lists to identify individuals and entities prohibited from participating in Minnesota Health Care Programs (MHCP). These exclusions are in place to protect program integrity and ensure that services are provided by qualified and compliant providers.

dhs.state.mn.us

Key Features:

Federal and State Exclusions:
- The Health and Human Services–Office of Inspector General (HHS-OIG) has the authority to exclude individuals and entities from participation in federal health care programs, including Medicare and Medicaid.
- MHCP excludes individuals and entities listed on both federal and state exclusion lists.
Accessing Exclusion Lists:
- Federal HHS-OIG Exclusions Database: A comprehensive list of individuals and entities excluded from federal health care programs.
- MHCP Excluded Group Providers: A list of group providers excluded from MHCP.
- MHCP Excluded Individual Providers: A list of individual providers excluded from MHCP.
Provider Responsibilities:
- Providers enrolling with MHCP must verify that all owners, managing employees, board members, and staff are not listed on exclusion databases.
- Regular checks should be conducted before hiring or contracting individuals or entities and ongoing (at least monthly) to ensure compliance.
Implications of Exclusion:
- No payment will be made by any federal health care program for items or services furnished, ordered, or prescribed by excluded individuals or entities.
- MHCP may recover funds paid to excluded providers if services were rendered during the exclusion period.
Removal from Exclusion Lists:
- Excluded providers must submit a written request to the DHS Program Integrity Oversight Division to be considered for removal from the state exclusion list.