States routinely fail to report health provider sanctions in the Medicaid program, HHS inspector generals office reported.
Providers suspended or excluded from participation, or otherwise sanctioned by state Medicaid agencies for reasons involving fraud, incompetence, or other problems, are subject to a permissive exclusion by the inspector general's office. The agencies are required to promptly report the providers to the inspector general's office whenever they take final actions against providers.
In its report, the inspector general's office found that about two-thirds of providers61% of the 4,319 sanctions imposed by state Medicaid agencies in 2004 and 2005were not found in the exclusions database.
States with high match rates were the states most likely to take action against more than 100 healthcare providers. However, two states that took final actions against the largest number of providers, New York and Florida, had two of the lowest match rates, 21% and 9%, respectively, the inspector generals office found.
Officials from state Medicaid agencies reported uncertainty about the types of information they should send in referring providers with final actions to the inspector generals office. Half of state Medicaid officials said they wanted additional guidance about the referral process.
In general, the agencies would welcome more information from the office about exclusions, the report stated.
OIGs results show that opportunities exist for both OIG and state Medicaid agencies to increase the number of referrals of providers with final actions, the report stated. -- by Jennifer Lubell