Medicaid providers employ excluded docs, OIG says

Medicaid managed care providers are employing individuals who are ineligible to serve Medicaid patients, according to an Office of Inspector General report released this weekend.

Of the 249,000 nurses, nurse-supervisors, aides, chaplains, and clinical and instrument technicians reviewed, 16 were excluded providers because of past convictions or license revocations. Moreover, nine of those excluded individuals provided direct patient care to Medicaid beneficiaries, the OIG noted.

The report found that incorrect names and misspellings led to the employment of several excluded individuals, as did contractors' failure to check the exclusion status of employees they supply.

Although most providers use safeguards, such as checking the OIG's list of excluded individuals to prevent ineligible employment, inadequate funds and resources make it difficult to take such precautions.

"It take[s] about 16 hours to look up every employee in two different databases ... It is very difficult to only be able to process one to five employees at a time depending on the database," one provider said in the report.

The agency noted that 13 excluded providers have since been terminated, with six directly due to the OIG review.

Earlier this year, the OIG found that the Centers for Medicare & Medicaid Services has allowed physicians who are barred from prescribing under Medicare Part D to prescribe more than $15 million worth of drugs.

To learn more:
- here's the OIG summary and report (.pdf)