Our Products
Get Started

An Introduction to the Texas Exclusion List

by

The Texas Exclusion list and all state Medicaid exclusion lists are critical components of an effective exclusion monitoring program. With more than 10,000 exclusions, Texas has one of the largest state lists, but the interface makes it a more user-friendly list than many.

In this post, we provide an overview of the Texas Exclusion List, how to screen against it, and a summary of the data it contains.

What is the Texas Exclusion List?

The Texas Exclusion List is the state’s exclusion database maintained by the Texas Health and Human Services, Texas Inspector General. Like the Medi-Cal List, the Texas Exclusion List is an extensive exclusion reference that reflects all providers currently excluded from the Texas Medicaid program.

Who needs to monitor the Texas OIG Exclusion List?

If your organization participates in federal healthcare programs (Medicare, Medicaid, CHIP, VA), either by directly furnishing goods or services or indirectly, but working with a healthcare provider, then you need to monitor the Texas OIG exclusion list.

Screening your healthcare populations against Medicaid exclusions are not only one of the most valuable defenses in protecting your organization and patients, but they also ensure the integrity of healthcare dollars. To ensure that healthcare employees are not on any exclusion lists, Medicaid providers must regularly screen all of their employees (from pre-employment and on an ongoing basis).

Organizations that employ or conduct business with an excluded provider may be subject to Civil Monetary Penalties (CMPs). CMPs enforced by HHS OIG or false claim allegations by the U.S. Department of Justice (DOJ) can result in more than $20,000 per false claim or statement, plus treble damages. Here are the latest CMPs published by the OIG.

How do I check the Texas Exclusion List?

To search the Texas Exclusion List, visit the Office of Inspector General’s website. Unlike some state lists where you can download a spreadsheet, the Texas Exclusion List has an interactive search function that allows you to manually search up to five individuals or company names simultaneously.

screenshot of the Texas Exclusion List search function

If you wish to identify if a provider was ever excluded from the Medicaid list (not a current exclusion), you will need to access the online downloadable exclusions file.

Identifying Matches on the Texas Exclusion List

When you’re trying to confirm whether an individual or entity appearing on the Texas exclusion list is, in fact, the same one within your population, you must confirm such a match based on uniquely identifying data points (not just a name or address). ProviderTrust’s best-in-class data enrichment strategy catches and verifies issues no one else can, alerting you to exclusions you would never otherwise find.

Data Completeness

When it comes to any exclusion list, data completeness is always a challenge. Within the Texas exclusion list, we find:
  • 80% have a license number
  • 3% have a National Provider Identifier (NPI)
  • 0% have a DOB
Because high-confidence, high-quality exclusion matches are only possible by matching uniquely identifying data (such as a SSN or NPI), it can be difficult and time-consuming to manually confirm Texas exclusions, and impossible to catch bad actors who may be using a different name or license.

How Texas Compares to Nearby States

The industry standard is to monitor healthcare populations (employees, providers, vendors) against all federal and state exclusion lists on an ongoing basis. Each month, we update our Exclusion Map with data from all federal and state exclusion or terminated provider lists for easy reference. Here’s a snapshot of the states surrounding Texas:

  • New Mexico and Oklahoma don’t have state exclusion lists
  • Louisiana has DOB, SSN verification, and 3% NPI reported
  • Arkansas has city, state, and zip code only

Reporting Timeline

When reviewing state exclusion lists, you’ll see that they’re all updated differently. While some are not updated regularly, others, such as the Texas Exclusion List, are updated continuously. Although there is no set update schedule, ProviderTrust regularly aggregates and enriches the latest primary source data to ensure our dataset remains more complete than most primary sources.

Texas Exclusion List FAQ

On average, it takes 121 days for Texas to report exclusions to the OIG LEIE.

The total number of Texas exclusions as of January 13, 2021, is 10,791. At the beginning of 2020, the number of reported exclusions was 10,629. At the end of 2020, the number rose to 10,783, making it a 1.4% increase. 

Currently, there’s no notification system in place. 

If you’re looking for current excluded providers, use the search function tool. If you’re investigating whether or not an individual/entity has ever been excluded from the Texas Medicaid program, you should download the file. Please note that the downloadable list contains the reinstated exclusions (with a reinstated date). While we remove these individuals/entities from monitoring, they will be present for anyone that downloads the list.

We suggest capturing the provider SSN so that you can use the SSN verification tool. If you don’t have a SSN but have the provider’s DOB, you might be able to conduct a successful search. The same goes for connecting a license and a DOB. 

Also, it should be noted that you can enter incomplete information into any search criteria. Examples include having the birth year only instead of the complete DOB and adding the first few letters of the provider’s name.

Are you ready for smarter OIG exclusion monitoring?

Share on facebook
Facebook
Share on twitter
Twitter
Share on linkedin
LinkedIn

Never miss an update

Get the latest healthcare news, advice from industry experts, and all things related to monitoring solutions delivered straight to your inbox.