Managed Care Default
Open-data reference.
Default on health education loan or scholarship obligations, or default by managed care entity on contractual obligations.
Recent Exclusions
| Name | State | Category | Date |
|---|---|---|---|
| JORGE JUAN BARQUET | FL | Licensed Healthcare Professional | 2020-03-19 |
| MICHELE M COYLE | CA | Licensed Healthcare Professional | 2020-02-20 |
| DANIEL ROBERT PERKINS | CO | Licensed Healthcare Professional | 2020-01-20 |
| KATHERINE LILY RICHMOND | OH | Physician | 2020-01-20 |
| BRIAN DAVID BOYD | WA | Licensed Healthcare Professional | 2019-11-20 |
| MICHAEL EARL DAWE | TX | Licensed Healthcare Professional | 2019-11-20 |
| J DEREK HOLLINGSWORTH | MT | Physician | 2019-11-20 |
| BRADY MATTHEW BISBOCCI | OH | Licensed Healthcare Professional | 2019-09-19 |
| AARON GLOSKOWSKI | AZ | Physician | 2019-09-19 |
| DARRYL CLARENCE SR HARRIS | GA | Physician | 2019-09-19 |
| PATRICIA DENISE PAYNE | CA | Licensed Healthcare Professional | 2019-09-19 |
| DAVID EDWARD STURGEON | CA | Licensed Healthcare Professional | 2019-09-19 |
| LEONARD G DUARTE | NJ | Licensed Healthcare Professional | 2019-08-20 |
| CHARLES N URQUHART | PA | Dental | 2019-08-20 |
| CECILIA F RINGSTAD | CA | Licensed Healthcare Professional | 2019-06-20 |
Managed Care Default by State
Actual exclusion counts from HHS OIG LEIE database by state.
Source: HHS Office of Inspector General — List of Excluded Individuals/Entities (LEIE) HHS Office of Inspector General — List of Excluded Individuals/Entities (LEIE)
What the Managed Care Default Numbers Reveal
The managed care default category currently accounts for 2,159 federal healthcare exclusions — roughly 15.6% of all active OIG LEIE entries. Exclusions under this category span 52 U.S. states, meaning licensing discipline in this specific action type is not concentrated in a single jurisdiction. California records the highest concentration with 592 excluded providers, while Texas follows with 194. Because this data comes directly from the HHS Office of Inspector General's monthly LEIE file, every entry reflects a formal federal debarment — not a pending allegation.
Default on health education loan or scholarship obligations, or default by managed care entity on contractual obligations. Patterns like this matter because healthcare organizations are legally required to screen employees, contractors, and referring providers against the LEIE before hiring and on an ongoing basis. A single billing interaction involving an excluded provider under the managed care default category can trigger civil monetary penalties of up to $100,000 per item or service furnished, plus treble damages. The 2,159 individuals and entities currently flagged represent an active compliance exposure for every hospital, clinic, pharmacy, and insurer operating in the affected states.
For patients and families, the state-by-state breakdown above is a starting point for verification — not a substitute for it. Exclusion status can change monthly as providers are added, reinstated, or moved between action categories. Before choosing a provider, always cross-check the current OIG LEIE at oig.hhs.gov and the relevant state medical board's public license verification tool. Because managed care default exclusions carry federal weight, they typically persist across state lines even if a provider relocates, making the LEIE the single most official source for confirming eligibility to receive Medicare, Medicaid, or TRICARE payments.
Frequently Asked Questions
What is a managed care default exclusion?
Managed Care Default is a type of exclusion action taken by the HHS Office of Inspector General (OIG) under federal law. When a healthcare provider receives this exclusion, they are barred from participating in Medicare, Medicaid, and all other federal healthcare programs. There are currently 2,159 managed care default exclusions across all U.S. states. Default on health education loan or scholarship obligations, or default by managed care entity on contractual obligations.
What is the impact on healthcare providers?
When a provider is excluded under the managed care default category, no federal healthcare program will pay for any items or services furnished, ordered, or prescribed by the excluded individual or entity. Healthcare organizations that employ or contract with excluded providers may face civil monetary penalties of up to $100,000 per item or service. Exclusions also affect the provider's ability to work in most healthcare settings, even in non-billing roles, since organizations risk penalties for any involvement of excluded individuals in federally funded care.
How can I check if a provider is excluded?
To check if a specific provider has been excluded, search the OIG's List of Excluded Individuals/Entities (LEIE) database at oig.hhs.gov. You can search by name, specialty, or state. The database is updated monthly and includes all currently excluded providers. Healthcare organizations are required to check the LEIE before hiring and on a regular basis (typically monthly) to ensure no current employees or contractors are excluded. The System for Award Management (SAM) exclusion database also contains exclusion records.
Can a provider be reinstated after exclusion?
Providers excluded under the managed care default category may apply for reinstatement after the minimum exclusion period has elapsed. The minimum period varies by exclusion type — mandatory exclusions under Section 1128(a) of the Social Security Act typically carry a minimum 5-year period, while permissive exclusions under Section 1128(b) can vary. The provider must submit a written request to the OIG and demonstrate that the circumstances that led to exclusion have been resolved. Reinstatement is not automatic and requires OIG approval.
Patient Resources
Guides to help you understand physician discipline and healthcare enforcement
Verify physician background, license status, and disciplinary history for free.
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Disclaimer: This information is provided for informational purposes only and does not constitute professional advice. Data is sourced from the HHS Office of Inspector General (OIG) and BLS. Consult a qualified professional before making decisions based on this data.
Read our methodology — how this data is sourced, computed, and verified.
All federal data sources used on this page
- U.S. Census Bureau ACS — demographic + housing + income data. census.gov/programs-surveys/acs
- BLS Occupational Employment and Wage Statistics (OEWS) — wage + employment by occupation. bls.gov/oes
- BEA Regional Economic Accounts — GDP + personal income by state/metro. bea.gov/data/regional
- U.S. Census Bureau County Business Patterns — establishment + employment by industry. census.gov/cbp
- IRS Statistics of Income (SOI) — tax-return aggregate data. irs.gov/statistics
- data.gov — U.S. federal open-data portal — discovery layer for additional federal sources. data.gov