Iowa Exclusion List

The Iowa Code section 249.49 (2013 Acts, ch 24, § 13) directs the Iowa Medicaid Program Integrity Unit to maintain an up-to-date list of providers that are found to be in violation of the Iowa Medicaid Program. This list identifies all providers that the Iowa Medicaid Program Integrity Unit has terminated, suspended, or placed on probation after administrative appeals have been exhausted, all providers that have failed to return an identified overpayment of medical assistance within the time frame specified in Iowa Code section 249A.39, and all providers found liable for a false claims law violation related to the medical assistance program under Iowa Code chapter 685.

• 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).