1. A. The BHSF director and the PIU section chief shall exclude any provider from the Medicaid program if the provider has:

   1. 1. been charged or convicted in court of a criminal offense related to the individual’s participation in any publicly funded healthcare program;
   2. 2. been excluded from any publicly funded healthcare program;
   3. 3. been charged with or convicted of a criminal offense related to neglect or abuse of patients in connection with the delivery of a health care item or service;
   4. 4. agreed to be excluded as part of a resolution of a matter pursued by any health oversight agency; or
   5. 5. failed to meet the terms and conditions of an agreement or judgment related to participation in a publicly funded healthcare program requiring the payment of money to the government.
2. B. No informal hearing or appeal is available when law or regulation requires an exclusion, except to contest the identity of the persons to whom the sanction applies.
3. C. No informal hearing or appeal is available when the excluded party consented to the exclusion in a written agreement.

4. D. An exclusion under this section is automatic. It may be longer, but not shorter in time, than:

   1. 1. in the case of a conviction, the criminal sentence imposed;
   2. 2. the exclusion for the federal or other state publicly funded healthcare program;
   3. 3. the length of time allowed for repayment; or
   4. 4. in the case of an agreed to exclusion, the length of time in the written agreement.
5. E. The exclusion is retroactive to the date of the event for which the exclusion is required. Proof of the charging, conviction, plea, exclusion, default of a repayment, settlement agreement, or judgment related to the Medicaid program can be made through provision of the documents evidencing the above or via affidavit.

6. F. Upon written request from an excluded individual, a mandatory exclusion shall be removed if the criminal matter upon which an exclusion is based is dismissed, overturned, set aside, or reversed on appeal.

   1. 1. The excluded individual shall submit supporting documentation that the criminal matter was dismissed, overturned, set aside, or reversed on appeal.
   2. 2. A dismissal based on Louisiana Code of Criminal Procedure article 893 or 894, or any other federal or state deferred adjudication provision, is not subject to this provision.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and 46:437.1-46:440.3.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health, Bureau of Health Services Financing, LR 52:696 (May 2026).