Washington State Exclusion and Termination List

The following list contains:

• Individuals or entities whose participation in the Medicaid program has been terminated for cause under the provision of WAC 182-502-0030.
• Medicaid providers who have been excluded from participation (see 42 CFR 1001).

Not every action taken by the Health Care Authority (HCA) involves a finding of wrongdoing (see WAC 182-502-0030 (b)). Individuals or entities terminated without cause pursuant to WAC 182-502-0040 are not included on this list.

The Affordable Care Act requires that all physicians or other professionals who prescribe, order, or refer services to Medicaid recipients must 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 order, prescribe, or make referral for 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).