NCJ Number
169188
Date Published
1997
Length
39 pages
Annotation
The process used by the Office of the Inspector General (OIG) of the Department of Health and Human Services (DHHS) to ensure the exclusion of health care providers that commit fraud or abuse or those that are incompetent was studied to determine its effectiveness in overcoming weaknesses revealed in a 1996 review by the General Accounting Office.
Abstract
The analysis used information from document reviews, site visits and interviews of several State Medicaid agencies, and follow-up at three OIG field offices. Findings revealed that the OIG has worked with State agencies to exclude thousands of providers over the years. However, remaining weaknesses include (1) lack of controls at OIG field offices to ensure that all State referrals received are handled promptly, (2) inconsistencies among OIG field offices regarding the criteria for excluding providers, (3) lack of oversight to ensure appropriate exclusion referrals, and (4) problems States experience in trying to identify and remove providers that appear on the OIG exclusion list. OIG officials attribute many of these problems to funding cutbacks in the past several years. Increased funding authorized in 1996 will provide additional staff and tools. In the interim, the DHHS Inspector General has initiated actions to improve the effectiveness of the exclusion process. These efforts are significant, but further refinements are needed. Footnotes and appended methodological information, case examples, and OIG comments