New Research Reveals 45% of Excluded Healthcare Providers Concentrated in Just 5 States Creating Hidden Compliance Risks

Comprehensive analysis of 7,212 excluded providers identifies geographic risk patterns that traditional compliance programs miss

SAN FRANCISCO, CA, UNITED STATES, May 16, 2025 /EINPresswire.com/ -- Assured, an NCQA-certified credentials verification organization, today released groundbreaking research revealing striking geographic concentration patterns of healthcare providers excluded from federal healthcare programs.

The comprehensive analysis of 7,212 excluded providers across 2,802 U.S. cities found that 45% are concentrated in just five states (California, New York, Florida, Ohio, and Texas), while one-third reside in only 100 cities nationwide. These "exclusion hotspots" create disproportionate compliance risks that most healthcare organizations fail to address with their current verification processes.

The study reveals that Ohio accounts for 8.25% of nationwide exclusions despite representing only 3.56% of the U.S. population—a concentration more than double what would be expected based on population alone. At the city level, New York City accounts for 3.74% of all nationwide exclusions, followed by Las Vegas with 1.59%.

"The concentration of excluded providers in specific urban areas isn't surprising, but the magnitude is striking," said Rahul Shivkumar, Co-Founder of Assured. "With over 33% of excluded providers concentrated in just 100 cities, healthcare organizations in these hotspots face a unique compliance challenge that traditional periodic screening simply can't adequately address."

The financial implications for healthcare organizations are significant. With penalties reaching $10,000 per claim plus triple damages for services provided by excluded individuals, organizations operating in high-risk regions face substantially elevated financial exposure if using the same verification processes as those in low-risk areas.
The geographic concentration patterns likely stem from several interrelated factors:

Regulatory enforcement variations across states
Higher provider density in metropolitan areas
Regional healthcare economics and reimbursement structures
Market complexity in urban healthcare delivery systems

Key findings from the analysis include:

Five states (CA, NY, FL, OH, TX) harbor 45.11% of all excluded providers
The top 21 cities account for 16.61% of all exclusions nationwide
Las Vegas has the highest concentration among major cities outside NY
Nevada shows the nation's highest per capita exclusion rate at 64.19 exclusions per million residents

"This data confirms what we've observed across the healthcare landscape—compliance risk isn't evenly distributed," said Varun Krishnamurthy, CEO and Co-Founder of Assured. "Organizations operating in these 100 high-risk cities need technology that continuously monitors their provider networks against exclusion databases. Without real-time verification, healthcare groups in these metropolitan hotspots are exposing themselves to significant financial penalties and reputational damage."

The report, "Uncovering Hotspots of Healthcare Provider Exclusions in the U.S.," includes detailed maps and city-by-city analysis that can help healthcare organizations better understand their geographic risk profile.

Assured's provider network management platform continuously monitors more than 2,000 primary sources for real-time verification, helping organizations identify excluded providers before they create compliance risks. The platform's geographic risk intelligence now incorporates the findings from this study to deliver regionally calibrated protection.

For more information or to download the full report, visit https://withassured.com/exclusion-report

About Assured
Assured is an NCQA-certified credentials verification organization that helps healthcare providers streamline credentialing, licensing, and payor enrollment across all 50 states. The company's automated platform reduces provider onboarding time by 80% while ensuring continuous compliance with federal and state regulations.

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Assured
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