Nebraska Medicaid Program

Program Integrity

Information on Sanctioned Providers

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To determine if an individual or entity is excluded (terminated or suspended) from participating in the Nebraska Medicaid Program, see the attached pdf titled Nebraska Medicaid Excluded Providers. If you have questions regarding an individual or entity that is excluded contact the Nebraska Medicaid & Long-Term Care Program Integrity unit, at 877-255-3092, P.O. Box 95026, Lincoln, NE 68509-5026, or via e-mail at DHHS.MedicaidProgramIntegrity@nebraska.gov.

UPDATED Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs
http://oig.hhs.gov/exclusions/files/sab-05092013.pdf

Information about federal exclusions, including databases of excluded individuals and entities, can be found on the Office of Inspector General’s website located at https://oig.hhs.gov/exclusions/index.asp and at the System for Award Management website located at https://www.sam.gov/portal/public/SAM/

PDF Nebraska Medicaid Excluded Providers

471 NAC 2-002.02 Definitions:

Suspension from Participation: An exclusion from participation in NMAP for a specified period of time.

Termination from Participation: A permanent exclusion from participation in NMAP.

471 NAC 2-002.05A Conditions of Suspension or Termination:

When a provider is suspended or terminated from NMAP, NMAP may not make reimbursement for services, items, or drugs that are provided, referred, furnished, or prescribed by the suspended or terminated provider or caused to be provided, referred, furnished, ordered, or prescribed for a Medicaid client.

471 NAC 2-002.05C Claims Submitted by an Excluded Provider:

Suspension or termination from participation of any provider shall preclude the provider from submitting claims for payment, either personally or through any clinic, group, corporation, or other association, to the Department for any services or supplies provided under NMAP, except for those services or supplies provided before the suspension or termination.

471 NAC 2-002.05D Excluded Person:

No clinic, group, corporation, or other association which is a provider of services shall submit claims for payment to the Department for any services or supplies provided by a person within the organization which has been excluded from participation in NMAP except for those services or supplies provided before the suspension or termination. If these provisions are violated by a clinic, group, corporation, or other association, the Department may suspend or terminate the organization and/or any individual person within the organization responsible for the violation. A provider shall not submit any claims to NMAP that contain the costs of services provided by excluded persons.

To determine if a facility, provider, employee, or contractor is excluded or prohibited from participation in Medicare and Medicaid on a nation-wide basis either contact the Program Integrity unit or visit the following websites: HHS-OIG located at www.oig.hhs.gov/fraud/exclusions.asp and GSA located at www.epls.gov/ . Providers enrolled in Nebraska Medicaid are required to screen facilities, providers, employees, and contractors for exclusion status using both websites. Please see PDFProvider Bulletin 09-02 for additional information.


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