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New Requirement and Sanctions: Check and Document Exclusions List Monthly

A new requirement effective Aug. 1 requires providers to document that they have checked the Minnesota Health Care Programs (MHCP) Excluded Group Providers and Excluded Individual Providers each month.  

Currently, providers are required to periodically check the exclusion list of individuals and entities who have been suspended or terminated from the state’s Medical Assistance program for program-related violations or misconduct. The new requirement to check and document the exclusions list monthly can be found in Minnesota Statute 256B.064, subd. 3.

The individual and group provider lists may be downloaded here.

Under the current Minnesota Medical Assistance rules, the DHS Surveillance and Integrity Review Section (SIRS) division may recover amounts paid for services provided by an excluded individual or entity (whether an employee or contractor) if the provider “knew or had reason to know of the suspension or termination.”

Listed in the new language are specific requirements and sanctions:

  • The vendor must check the exclusion list each month and document the date and time the exclusion list was checked and the name and title of the person who checked the exclusion list. The vendor must immediately terminate payments to an individual or entity on the exclusion list.
  • A vendor’s requirement to check the exclusion list and to terminate payments to individuals or entities on the exclusion list applies to each individual or entity on the exclusion list, even if the named individual or entity is not responsible for direct patient care or direct submission of a claim to medical assistance.
  • A vendor may be subject to a civil monetary penalty of up to $25,000 for each determination by DHS that the vendor employed or contracted with an individual or entity on the exclusion list.

Some of those listed on the exclusion list include physicians, podiatrists, physical therapists, social workers, private duty nurses, transportation providers, home health providers, medical suppliers, and personal care attendants.

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