- List of Suspended or Excluded MassHealth Providers (05/31/2016)
Individuals and entities that MassHealth has suspended or excluded from participating in MassHealth are identified in the list above. They are listed according to the provider type at the time of such action.
In accordance with the Patient Protection and Affordable Care Act (Pub. L. 111-148) enacted on March 23, 2010, as revised by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152) enacted on March 30, 2010, together known as the Affordable Care Act (ACA), the MassHealth program is required to terminate enrollment of any provider that is excluded under Medicare or by any other state Medicaid agency.
MassHealth suspends or excludes a provider when the
- provider's license or authorization to provide services is made inactive, terminated, suspended, or revoked by any authorizing board or entity;
- provider has been convicted of health-care fraud;
- provider has been suspended or excluded from another state’s Medicaid program;
- Medicare program has initiated an exclusion of a provider that is binding upon the Medicaid program;
- provider has pleaded guilty to, or was convicted of, a criminal activity materially related to the Medicare or Medicaid programs; or
- U.S. Department of Health and Human Services initiates an action that is binding on a provider's participation in the Medicaid program.
In addition, it is important to note that MassHealth, at its discretion, may also suspend a provider who fails to comply with participatory requirements of the MassHealth program.
A suspended or excluded provider is prohibited from billing MassHealth for any service provided to any MassHealth member in all categories of services. The provider's suspension or exclusion precludes MassHealth from paying the provider for furnishing, ordering, or prescribing services or items to a MassHealth member.
MassHealth updates its list on a monthly basis, and all participants in the MassHealth program must review each updated list to ensure that they are in compliance with the proper billing practices of MassHealth regarding suspended or excluded providers.
In order to participate in the MassHealth program again, a suspended or excluded individual or entity must submit an application for re-enrollment and cannot submit claims for services provided to MassHealth members until they are notified that their application has been approved.
The federal Office of the Inspector General maintains its own separate list of excluded providers, and information on that list can be found here: http://www.mass.gov/eohhs/docs/masshealth/bull-2009/all-196.pdf.
If you have any questions about the information on this page, please contact MassHealth Customer Service Center via e-mail at PRC@MAHealth.net or by mail at MassHealth Customer Service Center, ATTN: PRC Coordinator, 55 Summer Street, 8th Floor, Boston, MA 02110.