News: Feds, states fail to communicate on dropped Medicare providers

September 19, 2008

When a state boots a health-care provider from its Medicaid program for incompetence, fraud, or patient abuse, it's supposed to inform the federal government so that the offenders will be barred from receiving any more federal funds. But that doesn't always happen.

When a state boots a health-care provider from its Medicaid program for incompetence, fraud, or patient abuse, it's supposed to inform the Department of Health and Human Services' Office of Inspector General (OIG), so that these offenders will be barred from receiving any more federal funds. But that is not always the case, according to an OIG survey. Sixty-one percent of the 4,319 state sanctions imposed in 2004 and 2005 couldn't be located in the feds' database. Poor reporting makes it easier for dubious providers to set up shop elsewhere, according to the OIG. Ironically, Florida and New York had the lowest matching rates-9 percent and 21 percent, respectively-despite being the two states that suspended the most providers. A dozen states provided incomplete data or reported taking no action against health-care providers in 2004 and 2005.