The MassHealth program maintains a list of providers who have been suspended or excluded from participating in the MassHealth program. This list is updated monthly and reflects suspensions or exclusions effective on or after March 23, 2010. They are listed according to the provider type at the time of such action.
Reasons for suspension or exclusion
Providers may be suspended or excluded due to
- Not complying with participatory requirements of the MassHealth program
- Being excluded under Medicare
- Suspension of exclusion by any other state Medicaid agency
- An inactive, terminated, suspended, or revoked license or authorization to provide services
- Conviction of health care fraud
- Pleading guilty to or being convicted of criminal activity materially related to Medicare or Medicaid
- The U.S. Department of Health and Human Services initiating an action that is binding on a provider's participation in the Medicaid program
If the period of suspension or exclusion expires, reinstatement rights into the MassHealth Program are not automatic. The individual or entity must submit an application for re-enrollment and cannot submit claims for services rendered to MassHealth members until they are notified that the application has been approved. Once approved, the provider’s name will be removed from the published list of suspended and excluded providers.
List of suspended and excluded providers
MassHealth updates the list of suspended or excluded providers on a monthly basis. The update is posted around the second week of the month for the previous month.
See below for the list.
Questions regarding this list can be directed to:
Entities participating or applying to participate in MassHealth
On a monthly basis, any entity participating or applying to participate in the MassHealth program must search the list on this page, as well as the list of excluded individuals and entities (LEIE) of the federal Office of Inspector General to determine if any existing employee, contractor, owner, or board member has been suspended or excluded from participation in the Medicaid program.
In addition, the provider must immediately report any discovered exclusion of an employee or contractor to the Executive Office of Health and Human Services Compliance Office.