Medicaid Does OIG's Dirty Work
On January 16, 2009, The Center for Medicaid and State Operations ("CMSO") issued a directive to all State Medicaid Directors to begin requiring Medicaid providers to ensure that individuals who are providing services to Medicaid beneficiaries are not excluded from participation in the Medicare or Medicaid program.
Normally, health care providers cross-check the HHS-OIG excluded provider list on a regular basis (usually annually or on a rotating annual basis, where a provider's staff is very large). The OIG has required such excluded provider checks as part of an effective compliance program for many years. But now, with this new letter from CMSO, the burden for such checks has been ratcheted up.
Until this letter issued last month, the burden for identifying excluded individuals who provide services in the Medicaid program was left with the States. Now, the States have placed the burden squarely on providers. Specifically, CMSO has directed States that they should advise all current providers to screen all employees and contractors to determine whether any of them have been excluded. States are suppose to require providers to "search the HHS-OIG website monthly to capture exclusions and reinstatements that have occurred since the last search." As always, providers need to immediately report to the State any exclusion information that is discovered.
Obviously, the big issue is whether OIG, CMSO and the States really expect every Medicaid provider to check ALL employees and contractors against the excluded provider list every month or whether providers can continue to check the list in a reasonable fashion given the size of its organization. I do know that some Michigan Medicaid providers, including community mental health agencies, are asking their contract hospitals to confirm that they are checking all employees on a monthly basis.
Providers who do not already check all employees and contractors against the excluded provider list, on a monthly basis, would do well to check with the Michigan Medicaid program to confirm whether the State intends to enforce such an unrealistic expectation on Medicaid providers who are already overly burdened by the Medicaid program, without adequate compensation. Certainly this is just another argument physicians will us to determine not to participate in the Medicaid program.
