Illinois Exclusion List

Healthcare and Family Services’ authority to impose sanctions on individuals and entities is contained in 305 ILCS 5/12-4.25 and Illinois Administrative Code Section 140.16. Also, individuals and entities voluntarily withdraw from participation in the Medical Assistance Program.

The effect of a sanction or voluntary withdrawal is that no program payment will be made for any items or services, including administrative and management services. Program payment will not be made to any entity in which a listed individual is serving as an employee, administrator, operator or in any other capacity for any services, including administrative and management services furnished, ordered or prescribed on or after the effective date of the sanction or voluntary withdrawal. Also, no payment may be made to any business or facility that submits bills for payment of items or services provided by such an individual or entity.

• Why it matters: Services ordered, referred, or rendered by excluded parties are non‑payable; employing or contracting with excluded providers risks recoupment and civil monetary penalties.
• What to verify: Legal name and aliases, NPI/Medicaid ID, license/board status, date of birth (if available), last known city/state, and exclusion effective/end dates.
• Update cadence: Typically updated monthly by the state. Record the file’s “as of” date and screen at hire and monthly thereafter.
• Compliance tips:
  • Cross‑check with OIG LEIE and SAM.gov and retain dated evidence of each search.
  • Add system blocks to prevent ordering/prescribing by excluded providers.
  • Document remediation steps for positive matches (schedule removal, claim holds, notifications).