OIG Research Suggest Its List Misses 6 of 10 State Sanctions

October 17, 2008 at 1:28 pm Leave a comment

Earlier this year, we highlighted an AP article that documented the inconsistencies between state level sanction records and the HHS OIG LEIE (List of Excluded Entities and Individuals).   Now we have a copy of the report of David Frank, Director, Medicaid Integrety Program Centers for Medicare & Medicaid Services.   

His memo, State Medicaid Agency Referrals to the Office of Inspector General Exclusions Program, OEI-01-06-00301, draws these conclusions:

  • About two-thirds of Providers with Final Actions Imposed by State Medicaid Agencies …Were Not Found in the Exclusions Database
  • Eleven States had a match rate of less than 25 percent, specifically:   Arkansas, DC, Florida, Massachusetts, Nebraska, Nevada, New York, North Carolina, Oklahoma, Rhode Island, and Wyoming.

You can check your own state and read the full report, State CMS Medicaid Referrals to OIG Exclusions.

The memo continues, “Providers who are suspended, excluded from paricipation or otherwise sanctioned by a State Medicaid agency …by State Medicaid agencies are subject to a permissive exclusion by OIG.”   In other words, if a healthcare provider uses federal Medicaid/Medicare funds to to pay a state-sanctioned provider, the healthcare provider can be considered in violation of the federal medicaid payment practices.   

Comprehensive medical and vendor credentialing programs MUST include state as well as federal sanction checks.

Entry filed under: HHS OIG LEIE, vendor credentials.

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