Office of Medicaid Inspector General (OMIG).

Validating Provider Eligibility

The Office of Medicaid Inspector General (OMIG) is a state specific government agency responsible for creating and maintaining that state’s medical exclusion database. This database identifies individuals who have been excluded from participating in a particular state’s Medicaid program.

During the period of exclusion, it is prohibited for an individual or organization to participate in any activities associated with providing medical care, services, or supplies to beneficiaries of medical assistance. This includes activities related to submitting claims or seeking payment for such medical care, services, or supplies. Each state’s Office of Medicaid Inspector General is searched differently.

In New York, each search starts with the subject’s name and is verified with their Social Security Number. Providers are advised to regularly consult the NYS Medicaid Exclusion List, typically every 30 days, as a recommended practice, unless specified otherwise by law or contract.

By utilizing this list, providers can ensure they do not submit claims for medical care, services, or supplies that are prescribed or ordered by unauthorized individuals or entities. Enrolled providers must verify that the individual is not listed on a medical exclusion list before fulfilling any orders or prescriptions. Penalties for working with an excluded individual can be extreme, so it is best to partner with a professional background screener to accurately verify the information for you.