Dive Brief:
- Hundreds of banned providers from Medicaid in one state were able to participate in another state's program, despite regulations established to stop them, according to a study by the Office of Inspector General in the Department of Health and Human Services.
- About half of the states were unable to terminate providers enrolled in private Medicaid managed care programs and some refuse to terminate those still licensed by a medical board.
- The ACA requires states to terminate providers banned by another state for reasons related to fraud, integrity or quality. However, the Centers for Medicare and Medicaid Services (CMS) does not require states to report terminated providers to a federal database that shares information.
Dive Insight:
There were 2,539 providers terminated by a state in 2011, and the report found 295 still participated in another state's Medicaid programs. In addition, 94 providers were paid $7.4 million for services performed after termination.
New Mexico topped the list with the most terminated providers still participating in its program with 33, followed by Massachusetts with 30. California paid terminated providers the most at $1.7 million, followed by Mississippi with $1.2 million.
The report stated that the number of terminated providers still participating in Medicaid may be underestimated because of poor record-keeping by the states. "The government hasn't done what is expected to do to keep providers who shouldn't be in the program out of the program," said Kevin Golladay, OIG regional inspector general for region VI.