The Need for Expanded Federal Exclusion Authority

Testimony was given on the need for expanded federal exclusion authority for medical practitioners to help ensure that Medicare and Medicaid recipients receive quality care. While reviewing Medicare and Medicaid operations, 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 relocate and continue to treat Medicare and Medicaid patients because existing federal exclusion authority does not permit a national exclusion of practitioners who are found by state licensing boards to have failed to meet minimum professional standards. GAO supports proposed legislation that would exclude practitioners from participation in the programs when they are: (1) excluded by any state Medicaid or Medicare program; (2) convicted of crimes or fraud; or (3) sanctioned by any state licensing board. The Department of Health and Human Services is establishing an information system which would include information on practitioners who have been excluded from health care payment programs that choose to participate in the information system. The proposed legislation would include provisions that would provide a legal basis to ensure that HHS receives from states the necessary data to implement the provision enabling exclusion of practitioners sanctioned by their state licensing boards.