Medicaid Exclusions

The Medicaid program wants to ensure that the best medical professionals participate in the Medicaid program. When it is determined that a provider should no longer be eligible to participate, the individual or the entity is placed on a list of excluded providers. To access this list, click on the link below, and please review the explanation and disclaimers regarding the NYS Medicaid Exclusion List. Providers with questions about exclusions should call the New York State Office of the Medicaid Inspector General (OMIG) at 518-486-9956.

Provider Fraud, Waste & Abuse

Some Medicaid providers engage in fraudulent activities. The Office of the Medicaid Inspector General reviews provider billing and other activities and investigates charges of fraudulent behavior in order to take all appropriate actions.  

  • Billing for Medicaid services that were not provided
  • Giving out, or billing for, unnecessary services
  • Selling prescriptions
  • Ordering unnecessary tests
  • Giving money or presents to consumers in return for agreeing to get medical care from someone
Enrollee Fraud, Waste & Abuse

The Office of the Medicaid Inspector General reviews enrollee utilization and investigates other charges of fraudulent behavior in order to take appropriate actions. Some types of enrollee fraud, such as forging prescriptions, are subject to criminal prosecution and will be referred to the appropriate authorities.

Examples of Enrollee Fraud

Examples of Enrollee fraud could include:

  • Lending a Medicaid Identification card to another person;
  • Forging or altering a prescription or fiscal order;
  • Using multiple Medicaid ID cards;
  • Intentionally receiving duplicative, excessive, contraindicated, or conflicting health care services or supplies; and
  • Re-selling items provided by the Medicaid program.

How to Report Fraud or Aubse

If you suspect that a provider or enrollee has engaged in any of the activities listed above or any other questionable activity: