The MDHHS sanctioned provider list is a public record maintained by the Michigan Department of Health and Human Services identifying healthcare providers barred from participating in the state’s Medicaid program. It is posted on the department’s website and updated as providers are added or removed.1Michigan Department of Health and Human Services. List of Sanctioned Providers Appearing on it means a provider cannot bill Michigan Medicaid, and in many cases cannot bill any federal healthcare program either.
Who the list matters to runs in three directions. Providers need to know what puts them on it and how to get off. Healthcare employers need to screen against it to avoid their own penalties. And anyone looking up a specific name needs to understand what the listing represents and what it does not.
What Puts a Provider on the List
Michigan’s Public Health Code, Act 368 of 1978, gives the state broad authority to investigate and sanction providers who fall short of professional standards.2Michigan Legislature. MCL Act 368 of 1978 – Public Health Code The grounds for discipline are set out in MCL 333.16221 and cover a wide range of conduct, including:
- Negligence or failure to exercise due care, including unsafe delegation to staff, whether or not a patient is actually harmed
- Incompetence, treated as a disqualification separate from negligence
- Fraud in obtaining fees, through misdemeanor or felony convictions involving fraudulent billing related to a health profession
- Any felony conviction, or a misdemeanor punishable by up to two years
- Substance use disorder that affects the provider’s ability to practice safely
- Lack of good moral character, applied case by case by the licensing boards
- Adverse action by another state’s licensing board, the federal government, or a military licensing authority, which Michigan can act on by itself
MDHHS investigates allegations, holds hearings, and can compel testimony under oath. Once it finds grounds, the case goes to the appropriate disciplinary subcommittee, which decides the sanction.3Michigan Legislature. Michigan Compiled Laws 333.16221 – Investigation of Allegations, Grounds for Disciplinary Subcommittee Action After a final disciplinary action, the department publishes the provider’s name and address and reports the action to MDHHS, the state insurance department, and federal healthcare agencies.4Michigan Legislature. Michigan Code 333.16241 – Publishing List of Names and Addresses of Disciplined Individuals
The Federal Exclusion Overlap
The MDHHS list does not operate alone. Under 42 U.S.C. § 1320a-7, providers who commit certain offenses face mandatory exclusion from all federal healthcare programs. The four mandatory categories are:
- Program-related crimes, meaning any criminal conviction tied to delivering items or services under Medicare or a state healthcare program
- Patient abuse or neglect convictions under federal or state law
- Healthcare fraud felonies, including theft, embezzlement, or breach of fiduciary responsibility connected to a healthcare program
- Felony convictions for unlawful manufacturing, distributing, or dispensing of controlled substances
The minimum exclusion period for these categories is five years.5Office of the Law Revision Counsel. 42 USC 1320a-7 – Exclusion of Certain Individuals and Entities From Participation in Federal Health Care Programs Permissive exclusion categories also exist for misdemeanor fraud, obstruction of investigations, and other misconduct, where the Secretary of Health and Human Services decides whether to exclude and for how long.
The federal Office of Inspector General maintains the List of Excluded Individuals/Entities (LEIE), and providers on it cannot bill Medicare, Medicaid, or any other federal health program. Providers excluded under the federal mandatory provisions remain on the MDHHS sanctioned list until they complete the minimum exclusion period and affirmatively request reinstatement from the sanctioning body. The Medicaid Director retains authority to extend or reduce a provider’s exclusion period when necessary to protect beneficiaries or the program.6Michigan Department of Health and Human Services. MSA 19-03 Bulletin
What Employers Have To Do
Every healthcare employer that bills a federal program is responsible for checking that none of its employees or contractors appear on an exclusion list. Billing for services performed by an excluded individual triggers federal penalties even when the employer did not know about the exclusion.
Under the Civil Monetary Penalties Law, 42 U.S.C. § 1320a-7a, an entity that arranges or contracts with someone it knows or should know is excluded faces a penalty of up to $20,000 for each item or service billed.7Office of the Law Revision Counsel. 42 U.S. Code 1320a-7a – Civil Monetary Penalties The employer also has to repay the federal program for every dollar reimbursed for the excluded individual’s services. A single excluded provider working for months before anyone checks can generate hundreds of thousands of dollars in liability.
For that reason, Michigan healthcare facilities should screen all employees and contractors against both the MDHHS sanctioned provider list and the federal LEIE before hiring and at regular intervals afterward. Both lists are freely available online, and MDHHS updates its list as additions and deletions occur.1Michigan Department of Health and Human Services. List of Sanctioned Providers
Challenging a Sanction
Providers facing a sanction can request an administrative hearing after receiving notice from MDHHS. These hearings follow the Michigan Administrative Procedures Act, which guarantees the right to present oral and written arguments, submit evidence on issues of fact, and cross-examine witnesses.8Justia. Michigan Administrative Procedures Act – Chapter 4, Procedures in Contested Cases An administrative law judge or an agency member presides, can administer oaths, issue subpoenas, and regulate the proceedings.
If the hearing goes against the provider, judicial review is the next step. Michigan law allows anyone aggrieved by a final administrative decision to seek direct review in court after exhausting administrative remedies.9Michigan Legislature. Michigan Code 24.301 – Judicial Review of Administrative Decisions The reviewing court can set aside an agency decision that was unsupported by competent, material, and substantial evidence; that violated a statute or the constitution; that exceeded the agency’s authority; or that was arbitrary and capricious. The court can affirm, reverse, modify, or send the case back for further proceedings.10Michigan Legislature. Michigan Code 24.306 – Review of Administrative Decisions, Scope of Review
Judicial review is confined to the existing administrative record. A provider planning to challenge a sanction should treat the administrative hearing as the primary chance to build that record, because by the time the case reaches court, the window for introducing new evidence has largely closed.
Getting Off the List
Removal is not automatic. For state-level licensing discipline, a provider whose license was revoked (other than permanently) cannot apply for reinstatement for at least five years from the effective date of the revocation. Providers whose licenses were permanently revoked are ineligible for reinstatement at all.11Michigan Legislature. Michigan Code 333.16245 – Reinstatement of Licenses and Registrations Permanent revocation is reserved for the most serious offenses, and certain felony convictions involving sexual assault, homicide, or patient abuse trigger it automatically.3Michigan Legislature. Michigan Compiled Laws 333.16221 – Investigation of Allegations, Grounds for Disciplinary Subcommittee Action
Federal reinstatement runs on its own clock. For providers with a defined exclusion period, the application process can begin 90 days before that period ends. Reinstatement is not granted simply because time has passed. The provider must submit a formal application and receive written confirmation from the OIG before participating in Medicare, Medicaid, or any other federal healthcare program again.12Office of Inspector General. Reinstatement Providers excluded under certain provisions who no longer hold any healthcare license in any state may be eligible for early reinstatement consideration after a minimum of three years, but that path is closed to anyone whose license was lost due to patient abuse or neglect.
Even after reinstatement, the record of the sanction persists. MDHHS reports all disciplinary actions to federal agencies, and the National Practitioner Data Bank keeps a permanent record. Future employers, credentialing committees, and licensing boards in other states will see the history, which often means the professional consequences of a listing outlast the listing itself.