Medicaid Payments to Terminated Providers

OBJECTIVE

Federal law requires States to terminate fraudulent or abusive providers from their Medicaid programs, including providers that have been terminated by Medicare, another State’s Medicaid program, or any Children’s Health Insurance Program.  To identify providers that have been terminated by other programs, CMS requires States to review the data in its Data Exchange (DEX) system.  This study will determine the extent to which providers listed in the DEX as revoked by Medicare or terminated by State Medicaid agencies were associated with Medicaid claims and encounters, as well as the amount of money paid for those claims and encounters.

TIMELINE

• May 15, 2026
  Announced
• Today
  Office of Evaluation and Inspections In-Progress
• Est FY2028
  Estimated Fiscal Year for Project Completion

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