Exclusions

About the Texas Exclusions Database

The Office of Inspector General works to protect the health and welfare of people receiving Medicaid and other state benefits. To help protect these recipients, OIG may prevent certain people or businesses from participating as service providers. The people or businesses who are excluded from participating as providers are added to the Texas Exclusions List.

A person, or entity, may be excluded for many reasons. These include, but are not limited to:

• A conviction for program-related fraud or patient abuse
• An adverse action by a licensing board, such as the Texas Board of Nursing, Texas Medical Board or Texas State Board of Pharmacy
• Being excluded from the Medicare program

Every service provider is responsible for making sure that no excluded individuals or entities are receiving state funds. Specifically, it is each provider's or person's responsibility to ensure that items or services furnished personally by, at the medical direction of, or on the prescription or order of an excluded person are not billed to the Titles V (Maternal and Child Health Services), XIX (Medicaid), XX (Block Grants for Social Services), and/or other HHS programs after the effective date of exclusion. This section applies regardless of whether an excluded person has obtained a program provider number or equivalent, either as an individual or as a member of a group, prior to being reinstated.

When a person or entity is excluded from Medicaid, Title V, Title XX, and other HHS programs,

• The person or entity will not be reimbursed for any item or service they may furnish.
• The person or entity may neither personally, nor through a clinic, group, corporation, or other means, bill or otherwise request or receive payment for any Title V, XIX, or XX, or other HHS programs, or request or receive payment from the Medicaid program.
• The person or entity may not assess care, or order or prescribe services to Title V, XIX, or XX, or other HHS programs recipients. This applies regardless of whether the services were provided directly or indirectly. Also, a clinic, group, corporation, or other entity is not allowed to submit claims for any assessments, services, or items provided by a person who is excluded from participation.
• Any entity that employs, or otherwise associates with, an excluded person is not allowed to include within a cost report, or any other documents used to determine an individual payment rate, a statewide payment rate or a fee, the salary, fringe benefits, overhead, or any other costs associated with the person excluded.
• If a person who is later excluded has written an order or prescription before the exclusion date, the prescription remains valid for the duration of the order or prescription.
• If, after a person or entity is excluded, they submit claims for payment, we may assess administrative damages and penalties.

All service providers should check OIG's exclusion list monthly.

If you discover a current employee has been excluded from Medicaid or another HHS program you have a responsibility to notify the OIG. To assist in the process the OIG has released a Self-Disclosure Protocol.