A new report from the HHS inspector general's office suggests that states are routinely failing to report when they sanction health providers participating in the Medicaid program. When providers are suspended or excluded from participation in a Medicaid program, or sanctioned in some other way by a state Medicaid agency for fraud, incompetence or other problems, they're subject to a permissive exclusion by the IG's office. State Medicaid agencies are supported to report these actions against providers promptly to the IG's office whenever the agency takes final action.
However, this doesn't usually happen. In its report, the IG's office found that about two-thirds of providers, or 61 percent of the 4,319 sanctions imposed by state Medicaid agencies in 2004 and 2005, weren't reported for inclusion in the exclusions database. Interestingly, the two states that took final actions against the largest number of providers--New York and Florida--had two of the lowest match rates with the exclusions database, or about 21 percent and 9 percent respectively.
To learn more about the report:
- read this Modern Healthcare report (reg. req.)