According to the report, 295 providers across the country who were terminated from their states' Medicaid programs for cause in 2011 were still billing other states' Medicaid programs in 2014. Under the Affordable Care Act, states are supposed to pull providers' from their Medicaid rolls if they've already been removed from another state's program for fraud, integrity or quality problems.
“The continued participation of these providers after their terminations for cause from other State programs presents a vulnerability to Medicaid,” according to the OIG report.
Of those 295 providers, 94 received $7.4 million from Medicaid after they had already been yanked from their original states' programs. State agencies said the other 201 providers never received Medicaid dollars. Still, the OIG report said it's “concerning” that those providers were allowed to continue treating Medicaid beneficiaries.
Fifteen of the providers received Medicaid payments of $100,000 or more, and one got more than $1 million.
The OIG blamed the issue on the lack of comprehensive data sources available to states that would allow them to identify all terminations for cause.
The OIG also noted that 25 of the 41 states that use managed care to deliver Medicaid services did not require providers participating through managed care to be enrolled with the state Medicaid agency. States cannot terminate providers who are not directly enrolled, the OIG said.
The OIG is recommending the CMS require state Medicaid agencies to report all terminations for cause. It's also recommending the CMS require state Medicaid programs to enroll providers participating in Medicaid managed care and work with states to create common terminology to help states identify providers terminated for cause.
