{"what_this_is":"State by state: the Medicaid agency, its exclusion list and how this platform reads it, and the state forms where a dated receipt is the supporting record. Where we hold no official link we say so.","count":51,"states":[{"st":"AL","state":"Alabama","medicaid_agency":"Alabama Medicaid Agency","exclusion_list":{"name":"Suspended / Sanctioned Providers","official_url":"https://medicaid.alabama.gov/content/8.0_Fraud/8.7_Suspended_Providers.aspx","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Alabama Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Alabama procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"AK","state":"Alaska","medicaid_agency":"Alaska Department of Health, Program Integrity","exclusion_list":{"name":"Excluded Provider List","official_url":"https://health.alaska.gov/Commissioner/Pages/ProgramIntegrity/default.aspx","access":"pdf","how_read":"Published as a PDF — this platform holds a dated copy and prints rows under the exact name."},"forms":[{"form":"Alaska Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Alaska procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"AZ","state":"Arizona","medicaid_agency":"Arizona AHCCCS","exclusion_list":{"name":"Provider Suspensions and Terminations","official_url":"https://www.azahcccs.gov/Fraud/Providers/actions.html","access":"pdf","how_read":"Published as a PDF — this platform holds a dated copy and prints rows under the exact name."},"forms":[{"form":"Arizona Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Arizona procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"AR","state":"Arkansas","medicaid_agency":"Arkansas DHS","exclusion_list":{"name":"Excluded Provider List","official_url":"https://dhs.arkansas.gov/dhs/portal/Exclusions/PublicSearch/","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Arkansas Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Arkansas procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"CA","state":"California","medicaid_agency":"California DHCS, Medi-Cal","exclusion_list":{"name":"Suspended and Ineligible Provider List","official_url":"https://mcweb.apps.prd.cammis.medi-cal.ca.gov/references/sandi","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"California Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"California procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"CO","state":"Colorado","medicaid_agency":"Colorado Department of Health Care Policy & Financing","exclusion_list":{"name":"Terminated Provider List","official_url":"https://hcpf.colorado.gov/provider-termination","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Colorado Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Colorado procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"CT","state":"Connecticut","medicaid_agency":"Connecticut Department of Social Services","exclusion_list":{"name":"Administrative Actions List","official_url":null,"access":"unlocated","how_read":"Official page not yet located by us — start at the state Medicaid agency's provider enrollment page."},"forms":[{"form":"Connecticut Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Connecticut procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"DE","state":"Delaware","medicaid_agency":"Delaware DHSS, Division of Medicaid and Medical Assistance","exclusion_list":{"name":"Sanctioned Providers","official_url":"https://medicaid.dhss.delaware.gov/provider/Home/ProgramIntegrityLanding/tabid/2102/Default.aspx","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Delaware Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Delaware procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"DC","state":"District of Columbia","medicaid_agency":"DC Department of Health Care Finance","exclusion_list":{"name":"Excluded Parties List","official_url":null,"access":"unlocated","how_read":"Official page not yet located by us — start at the state Medicaid agency's provider enrollment page."},"forms":[{"form":"District of Columbia Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"District of Columbia procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"FL","state":"Florida","medicaid_agency":"Florida Agency for Health Care Administration","exclusion_list":{"name":"Sanctioned Providers","official_url":"https://apps.ahca.myflorida.com/dm_web/","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Florida Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Florida procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"GA","state":"Georgia","medicaid_agency":"Georgia Department of Community Health, Office of Inspector General","exclusion_list":{"name":"List of Excluded Individuals and Entities","official_url":"https://dch.georgia.gov/office-inspector-general/georgia-oig-exclusions-list","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Georgia Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Georgia procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"HI","state":"Hawaii","medicaid_agency":"Hawaii Med-QUEST Division","exclusion_list":{"name":"Provider Exclusion / Reinstatement List","official_url":"https://medquest.hawaii.gov/en/plans-providers/provider-exclusion-reinstatement-list.html","access":"pdf","how_read":"Published as a PDF — this platform holds a dated copy and prints rows under the exact name."},"forms":[{"form":"Hawaii Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Hawaii procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"ID","state":"Idaho","medicaid_agency":"Idaho Department of Health and Welfare","exclusion_list":{"name":"Medicaid Provider Exclusion List","official_url":null,"access":"unlocated","how_read":"Official page not yet located by us — start at the state Medicaid agency's provider enrollment page."},"forms":[{"form":"Idaho Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Idaho procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"IL","state":"Illinois","medicaid_agency":"Illinois HFS Office of Inspector General","exclusion_list":{"name":"Provider Sanctions","official_url":null,"access":"unlocated","how_read":"Official page not yet located by us — start at the state Medicaid agency's provider enrollment page."},"forms":[{"form":"Illinois Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Illinois procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"IN","state":"Indiana","medicaid_agency":"Indiana FSSA, Office of Medicaid Policy and Planning","exclusion_list":{"name":"Terminated Providers","official_url":"https://www.in.gov/fssa/ompp/provider-information/termination-of-provider-participation-in-medicaid-and-chip","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Indiana Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Indiana procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"IA","state":"Iowa","medicaid_agency":"Iowa HHS, Iowa Medicaid","exclusion_list":{"name":"Excluded Individuals and Entities (Sanctions List)","official_url":"https://hhs.iowa.gov/programs/welcome-iowa-medicaid/provider-services/excluded-individuals-and-entities","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Iowa Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Iowa procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"KS","state":"Kansas","medicaid_agency":"Kansas Department of Health and Environment (KMAP)","exclusion_list":{"name":"Termination List","official_url":"https://www.kdhe.ks.gov/172/Medicaid","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Kansas Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Kansas procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"KY","state":"Kentucky","medicaid_agency":"Kentucky Department for Medicaid Services","exclusion_list":{"name":"Terminated and Excluded Providers","official_url":"https://www.chfs.ky.gov/agencies/dms/dpi/pe/Pages/terminated.aspx","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Kentucky Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Kentucky procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"LA","state":"Louisiana","medicaid_agency":"Louisiana Department of Health","exclusion_list":{"name":"Adverse Actions List","official_url":"https://adverseactions.ldh.la.gov/SelSearch/","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Louisiana Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Louisiana procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"ME","state":"Maine","medicaid_agency":"MaineCare Services","exclusion_list":{"name":"Excluded Providers","official_url":"https://mainecare.maine.gov/mhpviewer.aspx?FID=MEEX","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Maine Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Maine procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"MD","state":"Maryland","medicaid_agency":"Maryland Department of Health, Medicaid","exclusion_list":{"name":"Sanctioned Provider List","official_url":"https://health.maryland.gov/mmcp/provider/Pages/sanctioned_list.aspx","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Maryland Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Maryland procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"MA","state":"Massachusetts","medicaid_agency":"MassHealth","exclusion_list":{"name":"Suspended or Excluded MassHealth Providers","official_url":"https://www.mass.gov/info-details/learn-about-suspended-or-excluded-masshealth-providers","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Massachusetts Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Massachusetts procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"MI","state":"Michigan","medicaid_agency":"Michigan MDHHS","exclusion_list":{"name":"List of Sanctioned Providers","official_url":"https://www.michigan.gov/mdhhs/doing-business/providers/providers/billingreimbursement/list-of-sanctioned-providers","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Michigan Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Michigan procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"MN","state":"Minnesota","medicaid_agency":"Minnesota DHS","exclusion_list":{"name":"Excluded Providers","official_url":"http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS-295094","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Minnesota Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Minnesota procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"MS","state":"Mississippi","medicaid_agency":"Mississippi Division of Medicaid","exclusion_list":{"name":"Sanctioned Providers List","official_url":"https://medicaid.ms.gov/providers/provider-terminations/","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Mississippi Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Mississippi procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"MO","state":"Missouri","medicaid_agency":"Missouri Medicaid Audit and Compliance","exclusion_list":{"name":"Sanction List","official_url":"https://mmac.mo.gov/providers/provider-sanctions/","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Missouri Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Missouri procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"MT","state":"Montana","medicaid_agency":"Montana DPHHS","exclusion_list":{"name":"Excluded or Terminated Providers","official_url":"https://dphhs.mt.gov/montanahealthcareprograms/terminatedexcludedproviders","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Montana Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Montana procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"NE","state":"Nebraska","medicaid_agency":"Nebraska DHHS","exclusion_list":{"name":"Medicaid Excluded Providers","official_url":"https://dhhs.ne.gov/Pages/Program-Integrity-Sanctioned-Providers.aspx","access":"pdf","how_read":"Published as a PDF — this platform holds a dated copy and prints rows under the exact name."},"forms":[{"form":"Nebraska Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Nebraska procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"NV","state":"Nevada","medicaid_agency":"Nevada DHCFP","exclusion_list":{"name":"Exclusions / Sanctions","official_url":"https://dhcfp.nv.gov/Providers/PI/PSExclusions/","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Nevada Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Nevada procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"NH","state":"New Hampshire","medicaid_agency":"New Hampshire DHHS","exclusion_list":{"name":"Exclusion and Sanction List","official_url":"https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-provider-relations","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"New Hampshire Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"New Hampshire procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"NJ","state":"New Jersey","medicaid_agency":"New Jersey Office of the State Comptroller, Medicaid Fraud Division","exclusion_list":{"name":"Ineligible Medicaid Providers","official_url":"https://www.nj.gov/comptroller/about/work/medicaid/ineligibleprovider.shtml","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"New Jersey Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"New Jersey procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"NM","state":"New Mexico","medicaid_agency":null,"exclusion_list":{"name":null,"official_url":null,"access":"none","how_read":"No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM."},"forms":[{"form":"New Mexico Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"New Mexico procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"NY","state":"New York","medicaid_agency":"New York State Office of the Medicaid Inspector General","exclusion_list":{"name":"NYS Medicaid Exclusion List","official_url":"https://omig.ny.gov/medicaid-fraud/medicaid-exclusions","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"New York Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"New York procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"NC","state":"North Carolina","medicaid_agency":"NC Medicaid, Division of Health Benefits","exclusion_list":{"name":"State Excluded Provider List","official_url":"https://medicaid.ncdhhs.gov/providers/excluded-providers","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"North Carolina Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"North Carolina procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"ND","state":"North Dakota","medicaid_agency":"North Dakota HHS","exclusion_list":{"name":"Terminated Provider List","official_url":"https://www.hhs.nd.gov/healthcare/medicaid/provider/compliance/fraud-and-abuse","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"North Dakota Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"North Dakota procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"OH","state":"Ohio","medicaid_agency":"Ohio Department of Medicaid","exclusion_list":{"name":"Provider Exclusion and Suspension List","official_url":"https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/enrollment-and-support/provider-enrollment/provider-exclusion-and-suspension-list","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"Ohio Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Ohio procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."},{"form":"OhioBuys supplier registration (Ohio DAS)","official_url":"https://ohiobuys.ohio.gov/","cite":"ORC 125; ORC 9.24 (unresolved findings for recovery — Auditor of State)","note":"Registration page held. Ohio's debarred-vendor list and ORC 9.24 unresolved-findings list are published by DAS and the Auditor of State; we hold no direct link."}]},{"st":"OK","state":"Oklahoma","medicaid_agency":null,"exclusion_list":{"name":null,"official_url":null,"access":"none","how_read":"No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM."},"forms":[{"form":"Oklahoma Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Oklahoma procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"OR","state":"Oregon","medicaid_agency":"Oregon Health Authority, Program Integrity Audit Unit","exclusion_list":{"name":"Convictions / Exclusions","official_url":"https://www.oregon.gov/oha/FOD/PIAU/Pages/Convictions.aspx","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Oregon Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Oregon procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"PA","state":"Pennsylvania","medicaid_agency":"Pennsylvania DHS","exclusion_list":{"name":"Medicheck List","official_url":"https://www.pa.gov/agencies/dhs/report-fraud/medicheck-list","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Pennsylvania Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Pennsylvania procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."},{"form":"PA Supplier Portal registration (Commonwealth vendor record; DGS Bureau of Procurement)","official_url":"https://pasupplierportal.state.pa.us/","cite":"62 Pa.C.S. (Procurement Code); Commonwealth contractor responsibility program","note":"Registration page held. The Commonwealth's debarment list and non-collusion affidavit form are published by DGS; we hold no direct link — locate on pa.gov/agencies/dgs."},{"form":"PennDOT ECMS contractor prequalification and FHWA-1273 on federal-aid projects","official_url":null,"cite":"67 Pa. Code ch. 457; 23 CFR 635.117","note":"ECMS is a login system (ecms.penndot.gov) — not read; FHWA-1273 above applies to every federal-aid contract."}]},{"st":"RI","state":"Rhode Island","medicaid_agency":null,"exclusion_list":{"name":null,"official_url":null,"access":"none","how_read":"No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM."},"forms":[{"form":"Rhode Island Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Rhode Island procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"SC","state":"South Carolina","medicaid_agency":"South Carolina Department of Health and Human Services","exclusion_list":{"name":"Excluded / Terminated Providers","official_url":"https://www.scdhhs.gov/fraud","access":"file","how_read":"Published as a downloadable file — this platform holds a dated copy and prints rows under the exact name (SHA-256 of the file as served)."},"forms":[{"form":"South Carolina Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"South Carolina procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"SD","state":"South Dakota","medicaid_agency":null,"exclusion_list":{"name":null,"official_url":null,"access":"none","how_read":"No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM."},"forms":[{"form":"South Dakota Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"South Dakota procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"TN","state":"Tennessee","medicaid_agency":"TennCare, Program Integrity","exclusion_list":{"name":"Terminated Providers","official_url":"https://www.tn.gov/tenncare/fraud-and-abuse/program-integrity.html","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Tennessee Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Tennessee procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"TX","state":"Texas","medicaid_agency":"Texas HHSC Office of Inspector General","exclusion_list":{"name":"Exclusions Database File","official_url":"https://oig.hhsc.state.tx.us/oigportal2/Exclusions/ctl/DOW/mid/384","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Texas Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Texas procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"UT","state":"Utah","medicaid_agency":null,"exclusion_list":{"name":null,"official_url":null,"access":"none","how_read":"No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM."},"forms":[{"form":"Utah Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Utah procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"VT","state":"Vermont","medicaid_agency":"Vermont Department of Vermont Health Access","exclusion_list":{"name":"Excluded Providers","official_url":null,"access":"unlocated","how_read":"Official page not yet located by us — start at the state Medicaid agency's provider enrollment page."},"forms":[{"form":"Vermont Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Vermont procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"VA","state":"Virginia","medicaid_agency":null,"exclusion_list":{"name":null,"official_url":null,"access":"none","how_read":"No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM."},"forms":[{"form":"Virginia Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Virginia procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"WA","state":"Washington","medicaid_agency":"Washington Health Care Authority","exclusion_list":{"name":"Provider Termination and Exclusion List","official_url":"https://www.hca.wa.gov/billers-providers-partners/become-apple-health-provider/provider-termination-and-exclusion-list","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Washington Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Washington procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"WV","state":"West Virginia","medicaid_agency":"West Virginia Bureau for Medical Services","exclusion_list":{"name":"Provider Exclusions and Terminations","official_url":"https://www.wvmmis.com/SitePages/Medicaid%20Provider%20SanctionedExclusion","access":"pdf","how_read":"Published as a PDF — this platform holds a dated copy and prints rows under the exact name."},"forms":[{"form":"West Virginia Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"West Virginia procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"WI","state":"Wisconsin","medicaid_agency":null,"exclusion_list":{"name":null,"official_url":null,"access":"none","how_read":"No separate state list located by us; the state agency's 455.436 check runs against the OIG LEIE and SAM."},"forms":[{"form":"Wisconsin Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Wisconsin procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]},{"st":"WY","state":"Wyoming","medicaid_agency":"Wyoming Department of Health, Medicaid","exclusion_list":{"name":"Provider Exclusion List","official_url":"https://health.wyo.gov/healthcarefin/medicaid/","access":"portal","how_read":"Published as a search application — this platform prints 'not read, official link' and the state agency's page; no automated reads of login or CAPTCHA pages."},"forms":[{"form":"Wyoming Medicaid provider enrollment application and disclosure of ownership, control and criminal convictions","cite":"42 CFR 455.104–455.106; 42 CFR 455.436 (state agency database checks at enrollment, re-enrollment and monthly)","official_url":null,"note":"Form number not held — locate on the state Medicaid agency's provider enrollment page. The dated LEIE + SAM + state-list receipt is the record behind the agency's 455.436 check and the provider's own disclosure."},{"form":"Wyoming procurement suspension/debarment certification or non-collusion affidavit","cite":"State procurement code; 2 CFR 200.214 and 2 CFR 180.300 when federal funds flow through the state","official_url":null,"note":"Published by the state procurement office; we hold no direct link unless listed below. The dated SAM read is the record behind the certification."}]}],"what_this_is_not":"Not legal advice, not a compliance determination, not a statement that any filer's certification is true or false. Form numbers and line numbers are as published on the date noted and may be renumbered by their agencies; the official page controls. Audit findings quoted are the auditor's words as filed at the Federal Audit Clearinghouse, cited by report id; they describe a documentation gap, not a conclusion about any party."}