Idaho Medicaid Exclusion List

Providers, individuals and entities named on the Idaho Medicaid Exclusion List consist of: 1) Providers, individuals and entities excluded by Idaho Medicaid; 2) Idaho providers, individuals and entities excluded by the Office of Inspector General (HHS-OIG); and 3) Providers, individuals and entities excluded by both Idaho and HHS-OIG. The Idaho Medicaid Exclusion List does not include all federally sanctioned providers, individuals and entities. Furthermore, state exclusion periods are often different than federal exclusion periods. Therefore, providers must check both the Idaho Medicaid Exclusion List and the HHS-OIG Exclusion List to determine whether a provider, individual, or entity is excluded and, if so, the dates of such exclusion.

• 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).