Here's what changed, how it affects you, and six simple steps to stay safe.
What changed?
On October 14, 2026, HHS gave CMS (the agency that runs Medicare and Medicaid) the power to exclude providers from Medicare, Medicaid and other federal health programs. Before, only the HHS Office of Inspector General (OIG) could do this. The change took effect immediately, and the OIG keeps its own power too.
CMS can now exclude providers for reasons such as:
- Losing or having a suspended license
- Billing for too much care, or care that wasn't needed
- Kickbacks
- False information on enrollment forms
How this affects your practice
Two agencies are now watching. CMS already reviews your claims, and now it can also ban you.
Faster action. CMS is focused on fraud and is expected to use this power.
Small errors matter more. Wrong enrollment details or unusual billing patterns can draw attention.
An exclusion is serious. An excluded provider can't bill Medicare or Medicaid, and practices that employ excluded people can face fines.
What to do now: 6 simple steps
How to turn this into an opportunity
Find lost revenue.
Coding audits often find services you're under-billing, not just errors.
Protect your reputation.
A clean record keeps you safe and helps when you negotiate with insurers.
Sleep better.
A simple monthly routine removes most of the risk.
The bottom line
Check your enrollment records, screen your staff monthly, and audit your coding once a year. An hour of prevention beats months of defending your practice.
Frequently asked questions
What does it mean to be excluded from Medicare?
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An excluded provider can't be paid by Medicare, Medicaid or other federal health programs, for their own services or as an employee of another practice.
How do I check if someone is excluded?
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Search the OIG exclusion list at exclusions.oig.hhs.gov, and check your state's Medicaid exclusion list. Do it before hiring and every month after.
What happens if I employ an excluded person?
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Your practice can face fines and may have to pay back money for services that person provided. That's why monthly screening matters.
Can an exclusion be appealed?
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Yes, through the HHS appeals process. If you receive any exclusion notice, contact a healthcare attorney immediately.
Feeling overwhelmed? HealthRescue Partners can help
If you're not sure where your practice stands, HealthRescue Partners can help. We can:
- Explain what this change means for you in plain terms
- Give you a simple compliance checklist and staff screening routine
- Help you spot billing patterns that could draw attention
Sources
- CMS gains new authority to exclude providers from Medicare, MedicaidBecker's Hospital Review, Oct 14, 2026
- CMS receives its exclusion authority: what happens nowNational Law Review
- OIG exclusion list search (LEIE)HHS Office of Inspector General
This article is general information, not legal or billing advice.