Medicheck (Precluded Providers) List

What is the Medicheck List?

The Medicheck List identifies providers, individuals, and other entities who are precluded from participation in the Medical Assistance (MA) Program. This List was previously sent monthly by way of an 88 series MA Bulletin. Effective January 2002, hard copies of the List were discontinued and all listings and updates are now issued through this site. Previous versions of Medicheck List Bulletins can be viewed from the Medical Assistance Bulletins page on this site. The Medicheck list can be searched by provider name, license number, business name, or by using the “Search by” pull-down menu; also available is a complete Medicheck list, sorted by provider last name.

Why is it necessary for MA providers (both in the fee-for-service and managed care delivery systems) to use the Medicheck Lis?

It is necessary for providers to examine the Medicheck list to assure that an order for a service or a prescription is not initiated by individuals who are no longer permitted to participate in the MA Program. Under applicable law, the Department and managed care organizations will not pay for any services prescribed, ordered, or rendered by the providers or individuals listed on the Medicheck List, including services performed in an inpatient hospital or long-term care setting. See 55 Pa. Code Sections 1101.42(c) and 1101.77(c). In addition, subsequent to the effective date of the termination or preclusion, any entity of which five percent (5%) or more is owned by a sanctioned provider or individual will not be reimbursed for any items or services rendered to MA recipients. It is your responsibility to utilize this on-line searchable listing to screen all employees and contractors (both individuals and entities), at the time of hire or contracting; and, thereafter, on an ongoing monthly basis to determine if they have been excluded from participation in the state and federal health care programs.

What is the LEIE data base, and why should providers use it in addition to the Medicheck List?

The List of Excluded Individuals/Entities (LEIE), maintained by the Department of Health and Human Services, Office of Inspector General (DHHS/OIG), is a data base of all individuals or entities that have been excluded nationwide from participation in any federal health care program, e.g., Medicaid and Medicare. Pursuant to federal and state law, any individual or entity included on the LEIE is ineligible to participate, either directly or indirectly, in the MA Program. The LEIE is easy to use and can be searched and downloaded from the OIG's web site at http://oig.hhs.gov/fraud/exclusions.asp. Although the Department makes best efforts to include on the Medicheck List all federally excluded individuals/entities who practice in Pennsylvania, providers should also use the LEIE to ensure that the individual/entity is eligible to participate in the MA Program.

Are providers automatically reinstated in the Medical Assistance Program at the end of a preclusion period?

No. In accordance with 55 Pa. Code Section 1101.82(a), providers who have reached the end of their preclusion period must request and be re-enrolled by the Department in order to participate.

How can a potential match be confirmed?

If, after searching The Medicheck list, you discover a potential match on an individual or entity, the Bureau of Program Integrity (the Bureau) can be contacted at 717-705-6872 to assist you in validating that match. Please note that the Bureau does not perform routine screenings for providers or contracted agencies hired to perform such screenings. In order to validate a potential match, the Bureau requests that you provide the following information via email @ RA-BPI-Preclusions@state.pa.us.

The name of the individual or entity
Date of Birth
Last four digits of the potential match’s social security number
License number of the potential match (if applicable)
Occupation of the potential match, for example: MD, RN, Housekeeper, or Speech Therapist.

Please allow 10 business days from the Department’s receipt of the request to receive a response.

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