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By Pari I. McGarraugh

Laptop and checkboxes with cross mark. Checklist with x mark on laptop screen. Choice, survey concepts. Modern flat design vector illustrationSince 2013, the Minnesota Department of Human Services (DHS) has maintained exclusion lists of individuals and entities who have been suspended or terminated from the state’s Medical Assistance program for program-related violations or misconduct. The individual and group provider lists may be downloaded here (click on “MHCP Excluded Group Providers” and “MHCP Excluded Individual Providers”).

An excluded provider or individual may not submit claims to Medical Assistance. Under the current Minnesota Medical Assistance rules, DHS’ Surveillance and Integrity Review Section (SIRS) division may recover amounts paid for services provided by an excluded individual or entity (whether an employee or contractor) if the provider “knew or had reason to know of the suspension or termination.” The Minnesota Health Care Programs Manual includes guidance that providers should check the state exclusion lists periodically.

An upcoming change to Minnesota law takes this Manual guidance and makes it binding in law. The relevant language is tucked in Minnesota’s recent health and human services omnibus bill, a monster of a session law spanning nearly 700 pages. The new law will be codified at Minn. Stat. 256B.064, subd. 3 and is effective August 1, 2019.

The new law requires vendors to check DHS’ exclusion list “on a monthly basis and document the date and time the exclusion list was checked and the name and title of person who checked the exclusion list.” The term “vendors” is not clearly defined, but legislative testimony provided by DHS indicates the agency understands this term to include professionals, transportation companies, PCA agencies, hospitals, and other individuals and entities who submit claims to Medical Assistance. The requirement to check is broad – vendors are to check their employees and contractors “even if the named individual or entity is not responsible for direct patient care or direct submission of a claim to medical assistance.”

If a vendor discovers that an employee or contractor appears on the list, the vendor is to “immediately terminate payments” to that individual or entity. The vendor must also refund any payment related to either items or services rendered by an individual or entity on the exclusion list dating back to the later of the individual’s or entity’s first appearance on the list or the first payment made to the individual or entity. In addition, the vendor may be subject to withholding or reduction of medical assistance payments, suspension or termination of medical assistance participation, and civil monetary penalties of up to $25,000 per individual or entity on the exclusion list.

Practically speaking, compliance with this requirement will impose significant administrative costs on providers and other vendors. The exclusion lists are structured as spreadsheets, which currently list 190 excluded group providers and 764 excluded individuals. The state’s website does not include a mechanism to run batch searches meaning that regulated parties will have to manually search the spreadsheets monthly for the names of every single contractor and employee and will have to document their compliance with this burdensome requirement or hire a third-party contractor to do so.

If you have concerns about complying with this new law or if you receive a Notice of Overpayment involving an excluded person, please contact us for assistance.


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