About 12 percent of healthcare providers barred from participating in the Medicaid program over fraud or other concerns continued to bill Medicaid from other states, according to a new report by the Office of the Inspector General.
Medicaid paid $7.4 million to 94 providers for services performed by providers that had been barred for reasons such as fraud, waste or quality, according to the OIG.
Twelve percent, or 295 out of 2,539 of providers terminated for cause in their states in 2011, continued participating in other states' Medicaid programs as late as January 2014, the OIG stated.
This is against Affordable Care Act requirement for states to block any providers already terminated for cause in another state.
The difficulty is that states often lack of a data source for identifying all terminations and have difficulty differentiating these from other administrative actions, the OIG report stated.
Further, some states do not enroll providers participating in its Medicaid managed care organizations and therefore are unable to take action to terminate the participation of the problem provider, according to the OIG.
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Some states also don't realize that active licensure status precludes terminating the provider for cause.
"We reiterate this prior recommendation as we found the lack of a comprehensive data source of providers terminated for cause creates a challenge for state Medicaid agencies," the OIG report said.
OIG also recommends CMS work with states to develop guidelines to clearly denote for-cause terminations; require that state Medicaid programs enroll all providers participating in Medicaid managed care; and furnish guidance to state agencies that termination is not contingent upon the provider's active licensure status.
Twitter: @SusanMorseHFN