Federally Excluded Providers in Colorado Carrier Networks

Providers on the OIG LEIE or SAM.gov exclusion list are federally prohibited from participating in Medicare, Medicaid, and all federal healthcare programs. When a carrier lists an excluded provider in their network directory, it creates multiple risks:

• Compliance violation: Carriers and employers who contract with excluded providers may face Civil Monetary Penalties (CMPs) under the Social Security Act.
• Patient safety: Exclusions are typically triggered by fraud convictions, patient abuse, license revocations, or other serious misconduct.
• Claims liability: Services rendered by excluded providers are not reimbursable by federal healthcare programs.