Ohio Medicaid Provider Exclusion and Suspension List

The Ohio Department of Medicaid (ODM) was founded in July 2013. It is the premier Executive-level Medicaid agency of the state of Ohio. Led by Director John B. McCarthy and in partnership with the Governor’s Office of Health Transformation, the ODM provides health care coverage to 2.9 million residents daily, through 83,000 providers.

Through the Ohio Revised Code, the Ohio Department of Medicaid has been granted rule-making authority which covers:

1.) Adoption of new rules.

2.) Amendment/Repealing of current rules.

These rules are accessible here: Medicaid Program Rules, Section 5160

One of ODM’s core commitments is to provide Ohio’s families and taxpayers with healthcare service of utmost efficiency and transparency through, among other things, a relentless fight against healthcare fraud.

Although the Ohio Department of Medicaid regularly updates its own list of suspended individuals/entities, which is accessible via this link: Ohio Medicaid Provider Exclusion Suspension List (Updated 2/12/2016), it nonetheless urges providers to conduct database searches using these sources:

• Office of Inspector General Exclusion Database
• System for Award Management
• Ohio Department of Developmental Disabilities Abuser Registry
• Ohio Auditor of State – Finding for Recovery Database

Questions related to Medicaid program exclusions and suspensions may be addressed to: [email protected].  State “Exclusions” in the subject line and include the individual’s full name (including middle initial) and the last four digits of their Social Security number.

Some stats from the LEIE regarding Ohio.

• 160 Number of exclusions in 2015 in the state of Ohio
• 748 – Number of exclusions in Ohio from years 2010-2014
• among the exclusions 2015 in Ohio are nurse/nurse aide, healthcare aide, pain management, home health agency, internal medicine, transportation co, OB/GYN, Podiatry & more.
• Exclusions handed out during 2015 in Ohio include but not limited to:
  • Conviction of program-related crimes 1,102
  • License revocation or suspension 493
  • Conviction relating to patient abuse or neglect 304
  • Felony conviction relating to healthcare fraud 253
  • Felony conviction relating to controlled substance 136

To learn more about LEIE stats see our infographic

 

Sources:

https://medicaid.ohio.gov/RESOURCES/Legal-and-Contracts/Rules

http://medicaid.ohio.gov/PROVIDERS/EnrollmentandSupport/ProviderExclusionandSuspensionList.aspx

https://medicaid.ohio.gov/MEDICAID-101/About-Us

http://oig.hhs.gov/exclusions/exclusions_list.asp

https://oig.hhs.gov/exclusions/authorities.asp

To learn more about State Medicaid compliance, visit our MEDICAID EXCLUSION LIST page.