States are not reporting those Medicaid providers that have been suspended or excluded from their state programs, according to a new report from the Department of Health and Human Services Office of Inspector General.
Nearly two-thirds of providers subject to these “final actions” by state Medicaid agencies were not placed in a federal database for the OIG to review. States are required to file final-action cases with the OIG for federal processing. Reasons for final action against providers can include professional competence, performance or financial integrity issues, among others.
One reason for the oversight could be confusion among state agencies, according to the OIG. Many state Medicaid offices are uncertain which information to send the OIG when it comes to final-action cases. Six of the 47 states surveyed did not even know they are required to file cases with the OIG, the report found.
To view the report, visit http://www.oig.hhs.gov/oei/reports/oei-01-06-00301.pdf.
