State Medicaid officials are challenging a new federal report that says their programs routinely fail to report health provider sanctions in the Medicaid program.
The report centers around an exclusions list of healthcare providers maintained by HHS inspector generals office that shows which providers are prohibited from getting payment from Medicare, Medicaid or any other federal health reimbursement program. State Medicaid agencies are required to promptly report providers to the inspector generals office whenever they take final action against providers that may have been cited for fraud, incompetence or other problems.
However, in a report issued last week, the inspector generals office determined that about two-thirds of providers61% of the 4,319 sanctions imposed by state Medicaid agencies in 2004 and 2005were not found in the inspector generals offices exclusions database.
The findings come as a surprise to some Medicaid officials, who claim theyre doing everything possible to report these sanctions to the federal government. We report everybody who needs to be sanctioned under Medicaid, said Paul Reinhart, director of Michigans Medicaid program. With a staff of 350 people running a $10 million state health insurance program, I dont know if theres more that we could do to improve compliance with the inspector generals office, he stated.
Currently there are 2,554 excluded organizations, and 40,640 excluded individuals in the inspector generals office database. In fiscal 2007, the office excluded 3,308 individuals and organizations, according to an agency spokesman.
To do its review, the inspector generals office matched data from its exclusions database with final actions taken by state Medicaid agencies in 2004 and 2005. In addition, the enforcement agency surveyed state Medicaid officials.
According to a chart from the report, at least a dozen states submitted incomplete data or reported not taking any action against healthcare providers during this time period, including Michigan and California, two states with large Medicaid populations.
Although Michigan was acknowledged for completing the inspector generals office survey, Reinhart was stumped by the results. Michigan has a deliberate process of sanctioning providers with its licensing agency, he said. If a provider is not on the federal list, then we share that with the federal government.
This isnt a clandestine approach, he continued. We put our results on our Web site. If the OIG is interested, then they can view the results and put them on their computers.
Discrepancies in the way the states and federal government treat exclusions may explain some of these results, said Mike Little, New Yorks deputy Medicaid inspector general for investigations and enforcement. New York state, for example, can exclude a provider based on a criminal indictment, in which a person is charged with a felony involving furnishing or billing for medical care, services or supplies. In the federal system, OIG doesnt exclude unless theres an actual conviction related to a healthcare service or delivery, Little said. Therefore, even if a state sent the inspector generals office an exclusion for an indictment, the federal government couldnt take an action on it, unless there was a subsequent conviction, he said.
Tennessee, another state cited for submitting incomplete data, responded to the OIG survey and provided data as requested. It appears that the OIGs data system was simply not compatible with our states data file for some reason, said Marilyn Wilson, a spokeswoman for TennCare, the states Medicaid program.
In general, the state agencies would welcome more information from the inspector generals office about exclusions, the report stated.