NY Medicare exclusions

Thousands of health care professionals in New York have been excluded from participating in Medicare, the federal health insurance program for elderly and disabled. Of that, hundreds of the exclusion cases involve doctors, nurses and others in the Lower Hudson Valley. The bans range in years depending on the level of offense, such as felonies related to health care fraud or drugs.

Search the database for cases separated by address, level of offense and other criteria.

    Key for type of exclusion:
  • 1128a1: Conviction of program-related crimes. Minimum exclusion period: 5 years.
  • 1128a2: Conviction relating to patient abuse or neglect. Minimum exclusion period: 5 years.
  • 1128a3: Felony conviction relating to health care fraud. Minimum exclusion period: 5 years.
  • 1128a4: Felony conviction relating to controlled substance. Minimum exclusion period: 5 years.
  • 1128b1: Misdemeanor conviction relating to health care fraud and non-health care programs: Minimum exclusion period: 3 years.
  • 1128b14: Default on health education loan or scholarship obligations. Minimum exclusion period: Until default has been cured or obligations have been resolved to Public Health Service's (PHS) satisfaction.
  • 1128b15: Individuals controlling a sanctioned entity. Minimum exclusion period: Same period as entity.
  • 1128b2: Conviction relating to obstruction of an investigation. Minimum exclusion Period: 3 years.
  • 1128b3: Misdemeanor conviction relating to controlled substance. Minimum exclusion period: 3 years.
  • 1128b4: License revocation or suspension. Minimum exclusion period: No less than the period imposed by the state licensing authority.
  • 1128b5: Exclusion or suspension under federal or state health care program. Minimum exclusion period: No less than the period imposed by federal or state health care program.
  • 1128b6: Claims for excessive charges, unnecessary services or services which fail to meet professionally recognized standards of health care, or failure of an HMO to furnish medically necessary services. Minimum exclusion period: 1 year.
  • 1128b7: Fraud, kickbacks, and other prohibited activities. Minimum exclusion period: None.
  • 1128b8: Entities controlled by a sanctioned individual. Minimum exclusion period: Same as length of individual's exclusion.
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