OIG Spots Gaps in State Medicaid Enrollment Procedures

WASHINGTON — When HHS’ Office of Inspector General
reviewed the records of 188 Medicaid providers excluded after
enrollment in 26 states, the review found:

• Eight of the 188 excluded providers disclosed false ownership
  information at the time of enrollment.
• Another eight of the 188 excluded providers had criminal
  convictions before they enrolled and committed health care-related
  crimes after they enrolled.
• 48 of the 188 had federal or state tax liens before or after
  they enrolled.
• 24 of the 188 had a history of tax debt, criminal convictions
  or false disclosures before they enrolled.

In other words, the OIG found in its review,
state Medicaid enrollment procedures aren’t exactly as tight as
they might be. According to a report from the OIG’s Office of
Evaluation and Inspections, the review revealed several “potential
weaknesses” in state enrollment procedures. While states are
required to collect ownership and criminal conviction information,
for example, they are not required to verify the accuracy of any
provider disclosures.

Neither do federal regulations require states to collect
information on tax liens or on convictions not associated with
federal health care programs.

Released May 19, the OIG report showed that a number of the
states included in the review imposed few enrollment requirements
beyond those mandated by the federal government. In fact, according
to the OIG, 132 out of the 188 providers were subject to no
additional state enrollment requirements.

Of the 56 providers who did have to go through additional
checks, 51 went through limited background checks through a search
of state databases only. There were site visits to only two
providers, and six had to reenroll in the program.

The reviewers looked at the criminal and financial backgrounds
of the 188 providers excluded from Medicaid between Jan. 1, 2007,
and June 30, 2008. However, the report said, “We were unable to
obtain complete enrollment files for 30 of these providers and
could not analyze their disclosures about ownership. We cannot
project our results to excluded Medicaid providers as a whole,
because the [List of Excluded Individuals/Entities]
contained Medicaid numbers for only 232 out of 4,991 excluded
individuals and entities, and we were unable to identify the
universe of excluded Medicaid providers.”

The OIG made no recommendations, and noted that CMS is “taking
steps to address provider enrollment,” as well as that the recently
passed health reform law imposes new screening requirements for
providers in Medicare, Medicaid and the Children’s Health Insurance
Program.

In 2007, a report from the Government Accountability Office
found that more than 30,000 Medicaid providers owed more than $1 billion
in unpaid federal taxes.

Download the complete
OIG report as a PDF.