HomeMy WebLinkAboutIdaho Medicaid Exclusion ListIdaho Medicaid Exclusion List - last updated June 9, 2025 Note: This list is not updated on a regular basis. It is updated when an entity or individual is added or reinstated.
The following providers, individuals and entities were excluded by the Idaho Department of Health
and Welfare and are excluded from participation in the Idaho Medicaid program. The Idaho Medicaid Exclusion List does not contain information about exclusion action taken by the Department of Health and Human Services Office of Inspector General (HHS-OIG) or other state agencies. 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. Information on
Medicaid exclusions by other states can be obtained on other state websites or by contacting states
where providers, individuals and entities billed. The HHS-OIG Exclusion List is accessed at http://exclusions.oig.hhs.gov.
Federal law prohibits payment for services rendered by state or federally excluded providers,
individuals and entities. Moreover, civil monetary penalties may be imposed against any providers
who use or contract with excluded providers, individuals or entities to provide items or services to
Medicaid participants. Providers are responsible for screening all employees and contractors to
identify excluded individuals and are responsible for searching the HHS-OIG website and the Idaho Medicaid Exclusion List monthly to capture exclusions and reinstatements. Providers, individuals and entities are not automatically reinstated at the end of the state or federal exclusion period. If
providers, individuals or entities on the state or federal exclusion lists do not have reinstatement
dates listed, they are not eligible to provide services.
Please e-mail exclusion verification inquiries to Prvfraud@dhw.idaho.gov.
Those wishing to again participate in Idaho Medicaid must apply for reinstatement and receive
authorized notice from Idaho Medicaid that reinstatement has been granted. Excluded
entities/individuals can begin the process of reinstatement no earlier than 120 days of the date
eligible for reinstatement. Entities and individuals that appear on the federal exclusion list are not
eligible to apply.
Requests for reinstatement need to be addressed to: Idaho Department of Health and Welfare; Medicaid Program Integrity Unit; Attention: Medicaid Reinstatement; 450 West State Street; 9th
Floor; Boise, Idaho 83702. The request must include the party’s name, address, phone number and
license or provider number (if applicable) and specifically state the party is requesting reinstatement.
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