Banned But Still Billing?
We cross-referenced 82,714 providers on the federal exclusion list with Medicaid billing records. 40 excluded providers appear in the data — and billing federal healthcare programs while excluded is a federal offense.
What Is the OIG Exclusion List?
The Office of Inspector General (OIG) maintains the List of Excluded Individuals and Entities (LEIE) — a federal database of healthcare providers banned from participating in Medicare, Medicaid, and all other federal healthcare programs. You can search the full exclusion database here. When a provider is excluded, no federal healthcare program may pay for any items or services furnished, ordered, or prescribed by that individual or entity.
Exclusions happen for serious reasons: conviction of program-related crimes (healthcare fraud, patient abuse, controlled substance offenses), license revocations, or other actions that demonstrate a provider is unfit to participate in federal programs. The consequences are severe — providers who bill while excluded face civil monetary penalties of up to $100,000 per item or service, treble damages, and potential criminal prosecution.
40 Excluded Providers in Medicaid Data
Our analysis cross-referenced the full OIG exclusion database — 82,714 excluded individuals and entities — against Medicaid billing records. We found 40 providers who appear in both datasets. These are providers with National Provider Identifiers (NPIs) that match between the exclusion list and active Medicaid billing records.
This finding warrants careful interpretation. Exclusion dates vary — some providers were excluded years before the billing period in our data, while others were excluded more recently. The presence of an excluded provider in billing data does not necessarily mean they billed after their exclusion date. However, it does mean these cases deserve scrutiny from state Medicaid agencies and federal oversight bodies.
Of the 40 matched providers, 34 (85%) were excluded for conviction of program-related crimes — the most serious category, indicating prior fraud, theft, or financial crimes against healthcare programs.
Why They Were Excluded
The exclusion reasons paint a concerning picture. The breakdown among our 40 matched providers:
- Convicted of program-related crimes: 34 providers (85%)
- License revocation/suspension: 3 providers (8%)
- Convicted of felony controlled substance: 2 providers (5%)
- Misdemeanor healthcare fraud: 1 provider (3%)
Program-related crimes dominate, which includes healthcare fraud, kickback schemes, and billing for services never rendered. License revocations and suspensions are the second most common reason, suggesting providers whose state medical boards found them unfit to practice.
Geographic Concentration
The 40 excluded providers aren't evenly distributed. The states with the most matches:
- NV: 8 providers
- CT: 5 providers
- FL: 3 providers
- NC: 3 providers
- MA: 2 providers
- MI: 2 providers
- MT: 2 providers
- NY: 2 providers
- GA: 2 providers
- TN: 2 providers
This geographic clustering may reflect the concentration of Medicaid spending in larger states, but it also suggests that certain state Medicaid programs may benefit from more aggressive cross-referencing against the federal exclusion list. Minnesota, for example, has 4× its population share of fraud-heavy exclusions — a pattern driven by home health, personal care, and transportation fraud.
What This Means for Patients
When an excluded provider continues to bill Medicaid, patients may unknowingly receive care from someone the federal government has deemed unfit. In cases where exclusion was due to patient abuse or neglect, this creates direct safety concerns. In fraud cases, it means taxpayer dollars continue flowing to providers with demonstrated histories of financial crimes.
Federal regulations require state Medicaid agencies to check the LEIE before enrolling providers and periodically thereafter. The fact that matches exist in the data suggests gaps in this screening process — or timing issues where exclusions occurred mid-billing period.
Explore the Data
We've made the full dataset available for public transparency:
- View all 40 matched providers → — See every excluded provider found in Medicaid billing data, with names, NPIs, exclusion dates, and reasons.
- Browse the full exclusion database → — Search 82,714 excluded providers. Check any NPI against the list.
We matched providers by National Provider Identifier (NPI) between the OIG LEIE database (updated January 2026) and Medicaid billing records (2018–2024). Exclusion may have occurred before, during, or after the billing period captured in our data. This analysis is presented for public transparency and does not constitute an accusation of wrongdoing. We encourage readers to examine the data and draw their own conclusions.