IG: Banned Medicaid providers getting around ObamaCare rule

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Some healthcare providers dropped by state Medicaid programs because of fraud or quality problems were still participating in other states’ programs, contrary to requirements in ObamaCare, according to an inspector general report

The Affordable Care Act requires that a state terminate a healthcare provider from Medicaid, the government health insurance program for the low income, if it is dropped for reasons like fraud or quality problems from a different state’s program.

{mosads}Despite this requirement, the Department of Health & Human Services’ inspector general found that 12 percent of providers terminated for cause in 2011 were still participating in other states’ Medicaid programs in January 2014. 

That translates to 295 providers and $7.4 million paid out even after termination by the initial state. 

To help fix the problem, the inspector general reiterated a previous recommendation that the Centers for Medicare & Medicaid Services (CMS) require states to report all terminations of providers for cause, rather than have reporting be voluntary, in order to make a comprehensive list of all terminated providers.

The inspector general notes, though, that CMS has not indicated that it plans to implement this requirement. 

“Although CMS described steps it had taken to improve the process of sharing information regarding terminated providers, it did not indicate that it planned to require State reporting of terminations,” the report states. 

CMS told the inspector general that since 2011 it has improved states’ ability to terminate fraudulent providers, including a stepped-up screening process as well as information sharing on providers cut off in other states. 

“CMS is committed to improving program integrity efforts in the Medicaid program,” CMS said. 


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