South Carolina Exclusion List

The State of South Carolina works diligently to prevent excluded providers from participating in the SC Medicaid program in order to comply with the federal regulations. Anyone appearing on this list should not submit claims for Medicaid reimbursement and should not be affiliated with any organization or facility that participates in the Medicaid program. In addition, providers cannot bill for any medicines, medical supplies or medical equipment that is prescribed or authorized by an excluded provider on behalf of a Medicaid beneficiary. If an organization or facility employs an excluded individual, this can result in the entire organization being excluded from the South Carolina Medicaid program.

• 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).