Termination of Provider Participation in Medicaid and CHIP

Federal regulation requires states to provide notice when the enrollment of a Medicaid enrolled provider has been terminated “for cause”. The following list reflects examples of conduct for which provider enrollments may be terminated and meets the definition of “for cause” as defined by CMS. The list is not meant to be exhaustive:

  • Adverse licensure actions
  • Federal exclusion
  • Fraudulent conduct
  • Abuse of billing privileges
  • Misuse of billing number
  • Falsified enrollment information
  • Falsified medical records.

Terminated providers

Re-enrolled providers