The Need for Expanded Federal Exclusion Authority

Testimony was given on the need to expand the Federal Government's authority to exclude unfit health care practitioners from the Medicare and Medicaid programs to help ensure that program recipients receive quality care. GAO found that it is possible for medical practitioners who hold licenses in more than one State to have one of these licenses suspended or revoked by a State licensing board but to relocate and continue to treat Medicare and Medicaid patients. These practitioners are able to continue practicing under Medicare and Medicaid because the existing Federal exclusion authority does not permit a national exclusion of practitioners who failed to meet the minimum professional standards of State licensing boards. The Department of Health and Human Services (HHS) can exclude practitioners from participation in Medicare for certain offenses. However, practitioners who lose their right to participate in the programs in a State for overutilization, providing inappropriate care, or criminal conviction can practice under the programs in any other State where they hold a license. GAO found that HHS needs the authority to nationally exclude them from participation in the programs. Proposed legislation is planned which would expand the current exclusion authority to cover convictions for drug-related offenses and other crimes. However, GAO recommended that the proposed legislation be expanded to provide for a national exclusion when a practitioner has been sanctioned by a State licensing board, and information on all practitioners sanctioned by States should be included in an information reporting system which HHS is establishing.