What is the Preclusion List?

Summary

This article reviews the CMS Preclusion List, which became effective in April 2019. It includes providers and prescribers barred from Medicare Advantage and Part D payments due to conduct deemed harmful to the Medicare program. It applies to those revoked from Medicare or who engaged in revocable behavior, even if not enrolled. Unlike exclusion lists, it is not publicly available.

The CMS Preclusion List is maintained by the Centers for Medicare & Medicaid Services (CMS) and went into effect in April 2019. Unlike the exclusion lists, the Preclusion list is not publicly available. 

Per CMS.gov, the preclusion list is "a list of providers and prescribers who are precluded from receiving payment for Medicare Advantage items and services or Part D drugs furnished or prescribed to Medicare beneficiaries."

Individuals or entities on the preclusion list would meet one of the following criteria:

• Currently revoked from Medicare, under an active re-enrollment bar, CMS has determined that the underlying conduct that led to the revocation is detrimental to the best interest of the Medicare program. 

OR

• Have engaged in behavior for which CMS could have revoked the individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare Program.

**Please Note: Preclusion List Monitoring is not included in the Exclusion Monitoring package; it is an additional product that requires the ProviderTrust client to supply a Delegation Agreement and the CMS Preclusion List. **