OIG-HHS report describes red flags in applications of medical providers subsequently excluded from federal healthcare programs

by Ben Vernia | May 20th, 2010

In a May 20 report, the OIG-HHS reviewed the applications of 188 medical providers who were subsequently excluded from participating in federal healthcare programs. Among the problems the OIG found:

  • Non-program convictions – several providers had been previously convicted for non-program offenses (which they are not obligated to report when applying for a provider number, including forgery, insurance fraud, and receiving stolen property;
  • Tax liens – state or federal tax liens had been imposed against 48 providers, and several received reimbursement from their states’ Medicaid programs despite the presence of the liens;
  • False ownership information – eight providers’ applications included false information that was not caught before they were enrolled.

Although states are permitted to implement additional screening measures to keep untrustworthy healthcare providers from enrolling, the OIG-HHS found that few did so. The OIG made no recommendations, noting that Congress (in the new healthcare reform act) and CMS were taking steps to address enrollment issues in the programs.

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