More than 65,000 providers are cut from Medicaid rolls in 15 states

A provision of the Affordable Care Act that requires providers to revalidate or recertify their Medicaid reimbursement eligibility has caused more than 65,000 providers to be stripped from the federal program, according to a Modern Healthcare analysis.

Providers that enrolled in Medicaid before March 25, 2011, had to send in revalidation notices to the CMS on or before Sept. 25, 2016, or risk being dropped.

The move was an effort to curb fraud, waste and abuse in the program.

Modern Healthcare received data from 15 Medicaid agencies around the country. There is no nationwide tally of the total number of providers that accept Medicaid.

But to give a ballpark estimate on impact, Texas cut more than 28,000, or nearly 10%, of its 298,000 Medicaid providers.

Some states were successful in receiving revalidation notices from providers, while others are just now evaluating their rolls because of staffing or technical limitations, according to officials at state Medicaid agencies.

States say many providers left Medicaid voluntarily. The programs have long been criticized in many states for low reimbursement, often paying 60% of the Medicare rate for medical services.

Indiana, which dropped 3,226 providers, found many providers left the state, enrolled for a single patient or no longer wished to participate, according to Jim Gavin, a spokesman for the state's Medicaid agency. Washington and Tennessee officials made similar comments.

The Medical Association of Georgia learned that letters mailed to providers were returned because addresses were not updated in the state's Medicaid system. It's unclear how many providers were ultimately un-enrolled.

A state Medicaid agency spokeswoman did not reply to a request for comment. Some providers worry that scrubbing doctors off state rolls will dilute access to care.

“The loss of any provider is dispiriting and will likely jeopardize patient access to care given concerns about network adequacy,” a spokesman for the Texas Medical Association said.

The American Medical Association and American Academy of Family Physicians said they haven't heard complaints about access.

And according to a report from the National Center for Health Statistics, about 69% of office-based physicians were accepting new Medicaid patients while around 84% accepted new Medicare patients.

Improper Medicaid payments hit $30 billion in 2015, according to the CMS. Medicaid's improper payment rate was 9.8% for 2015, nearly double what it was in 2013. The agency has yet to release its 2016 report on improper payments, but it had said previously it anticipates the rate to hit 11.5% for the year.

Improper payments are defined as any payment that should not have been made or that was made in an incorrect amount; such payments are not all the result of fraud, though the tally includes fraudulent claims.

Recent rules and legislation have tried to curb that behavior. The 21st Century Cures Act, which initially was written to expedite the approval of some drugs and change how medical research is funded and was recently signed into law, included a provision that creates a centralized federal database that lists providers terminated by Medicaid in any state.

It also builds centralized enrollment standards that explain what doctors must submit to enroll into Medicaid. Unlike Medicare, Medicaid has no national enrollment database for providers. Instead, providers enter into agreements directly with the states.