Fraud and Abuse

Providers Excluded From Medicaid Continue to Participate in Federal Health Programs Gao ID: T-HEHS-96-205 September 5, 1996

Although the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) has excluded thousands of health care providers from state Medicaid programs because they committed fraud or delivered poor care to beneficiaries, weaknesses in the OIG's process could leave such providers on the rolls of federal health programs for unacceptable periods of time. This puts at risk the health and safety of beneficiaries and compromises the financial integrity of Medicaid, Medicare, and other federal health programs. The weaknesses include (1) lengthy delays in the OIG's decision process, even in cases where a provider has been convicted of fraud or patient abuse and neglect; (2) inconsistencies among OIG field offices regarding which providers will be considered for nationwide exclusion; (3) states not informing the OIG about providers who agree to stop participating in their Medicaid programs even though the provider withdrew because of egregious patient care or abusive billing practices; and (4) how states use information from the OIG to remove excluded providers from state programs. Because of incomplete records in the OIG field offices, GAO could not reach a conclusion as to the magnitude of these problems.



The Justia Government Accountability Office site republishes public reports retrieved from the U.S. GAO These reports should not be considered official, and do not necessarily reflect the views of Justia.