List of Sanctioned Providers
Pursuant to Section 1128 and Section 1902(a)(39) of the Social Security Act, the Medicaid Program will not reimburse a provider for any services or items that were rendered or ordered/prescribed by a sanctioned (e.g., suspended, excluded) provider. The effect of the provider's sanction precludes them from furnishing, ordering, or prescribing services or items to any Medicaid beneficiary. Claims for services/items rendered/ordered/prescribed by a sanctioned provider with dates of service or dispensing after the effective date of the publishing of the sanction, will be rejected or disallowed if discovered during a post-payment review. Refills of prescriptions written by a sanctioned provider must not be dispensed beyond the effective date of the bulletin. Claims for services/items rendered/ordered/prescribed by a provider for whom sanctions have been removed will be honored retroactively to the date the sanction ended.
Special Billing Instructions
For customized durable medical equipment, the equipment must be authorized and ordered prior to the effective date of the notifying bulletin. When billing for these items, the order date must be indicated as the date of service and the delivery date noted in the remarks area of the invoice.
Sanctioned Provider List
The MDCH Sanctioned Provider List reflects the sanctioned provider's name, NPI (if available), license/certification number if applicable), along with the sanctioning authority, sanction date and reason for sanction*. As additions and deletions are made to the list, the changes will be published in Medicaid Policy Bulletins. MDCH does not publish paper copies of the complete.
When the sanctioning body enddates a provider's sanction, that provider is removed from the MDCH Sanctioned Provider List, but is not automatically reenrolled with MDCH. Provider's wishing to reenroll with MDCH must complete a new application process.
Supplemental Sanctioned Information
MDCH makes every effort to publish sanction information related to its enrolled providers. However, since this information often comes from sources outside of MDCH, there may be instances of providers not appearing on the list. In addition, some providers (e.g., Adult Foster Care) are not currently enrolled with MDCH although they provide services for Medicaid beneficiaries. For that reason, the following sources should also be monitored to assure services are not provided by a sanctioned individual or entity.