Vermont Excluded Providers List

This list may not be considered comprehensive of all providers excluded from participation in the Vermont Medicaid program; action by other federal or state entities may also result in exclusion. The providers identified herein are those that have been excluded by the Vermont Department of Health Access and the Agency of Human Services. This list may or may not include providers excluded as a result of action taken by other federal or state entities.

The Affordable Care Act requires that all ordering physicians or other professionals who prescribe, order, or refer services to Medicaid or provide services under the State Plan or under a waiver of the plan to be enrolled as participating providers (see 42 CFR 455.410(b)). Therefore, any non-enrolled provider, including any provider who is terminated from the Medicaid Program, for any reason, is not permitted to provide services to Medicaid recipients.

• 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).