Arkansas Medicaid Exclusion

Arkansas Medicaid Exclusion

Arkansas medicaid exclusion

 

All you need to know about Arkansas Medicaid Exclusions

The Arkansas Medicaid Inspector General (OMIG) was established on April 23, 2013, in pursuant to the Arkansas Act 1499, whose purpose include:

  •         The creation of a new state agency that shall consolidate into one office all Medicaid fraud detection prevention and recovery measures.
  •         The creation of an improved organizational structure characterized by efficiency and accountability.
  •         The reorganization and streamlining of the state’s Medicaid fraud and abuse detection.
  •         And the optimization of improper Medicaid payments recovery.

The Arkansas OMIG houses the Program Integrity Unit of the Arkansas Department of Human Services. Its core functions include:

  •         Audit of Medicaid providers.
  •         Audit of medical assistance program.
  •         Case referrals for criminal prosecution.

On June 11, 2015, Inspector General Elizabeth Smith was appointed by Governor Asa Hutchinson, and under her leadership, the Arkansas OMIG continue to foster its mission “to prevent, detect, and investigate fraud, waste, and abuse within the medical assistance program.”

For the Fiscal Year of 2015, the Arkansas OMIG has accomplished the following:

  •         $2,353,079.66 overpayment recoveries
  •         $3,061,890.75 (approximately $1 million increase from 2014) recoupments and reversals of claims and payments
  •         11 provider suspensions
  •         1 provider termination
  •         66 (more than 100% increase from 2014) provider exclusions
  •         47 investigations referred to the Medicaid Fraud Control Unit (MFCU)
  •         16 fraud cases charged
  •         5 convictions
  •         29 self-disclosures= $59, 648.14
  •         282 fraud complaints made through the website

The Arkansas OMIG tracks and operates a dedicated self-disclosure sub-unit. The self-disclosure process follows this guideline:

  1.   Transmittal

The disclosure must be submitted in writing to the Office of the Medicaid Inspector General, P.O Box 1437, Slot S-414, Little Rock, AR 72203-1437.

  1.   Contents of Report

The submission should include the following information:

  1. Name, address, provider identification number(s), other provider billing number(s), and tax identification number(s) of the disclosing Medicaid Provider.

If the provider is an entity that is owned, controlled or is otherwise part of a system or network, include a description or diagram describing the pertinent relationships and the names and addresses of any related entities, as well as, any affected corporate divisions, departments or branches.

  1. Name and address of the disclosing entity’s designated representative for purposes of the voluntary disclosure.
  2. Whether the Medicaid Provider has knowledge that the matter is under current inquiry by any government agency or contractor. If so, identify the governmental entity or individual representatives involved.
  3. Whether the Medicaid Provider is under investigation or other inquiry for any other matters relating to a state or federal health care program. If so, identify the nature of the investigation and the governmental entity or individual representatives involved.
  4. Full description of the nature of the matter being disclosed, including the type of claim, transaction or other conduct giving rise to the matter, the names of entities and individuals believed to be implicated, and an explanation of their roles in the matter.
  5. Dates of the program violations and any other relevant periods.
  6. The type of health care program affected, as well as any other involved parties, such as contractors, carriers, intermediaries and third party payers.
  7. Citations to any state or federal laws or regulations that may have been violated, along with the reasons why the disclosing provider believes that a statutory or regulatory violation may have occurred.
  8. Citations to any program policies that may have been violated, along with the reasons why the disclosing provider believes that a program violation may have occurred.
  9. A certification by the Medicaid Provider stating that the submission contains true, accurate, and complete information, and that there are no material misstatements or omissions of fact or law. If the provider is a business entity, an authorized representative of the entity may execute the certification.
  10.   Additional Substantive Information

As part of its participation in the disclosure process, the disclosing Medicaid Provider will be expected to conduct an internal investigation and a self-assessment, and then report its findings to the OMIG.

To report suspected fraud, concerned citizens may file a direct complaint through the Arkansas OMIG’s website: http://omig.arkansas.gov/fraud-form/

OIG Exclusion data for the State of Arkansas

  • 186 OIG exclusions all time since June, 1989.
  • From the years 2011-2015 there was a total of 94 exclusions on the LEIE.
  • Average number of exclusions from the State of AK from the years 1989-1999 is less than 2/year.
  • The average number of exclusions/year rose to close to 10 from year 2000-2015.
  • OIG Excluded Individuals & Entities in Arkansas include but not limited to:
    • Healthcare Aide
    • Nurse or Nurse Aide
    • Personal Care Provider
    • Transportation Company
    • Assisted Living Facility
    • Osteopathy
    • Pharmacist

 

Resources:

http://mig.arkansas.gov/about-us/

http://oig.hhs.gov/exclusions/exclusions_list.asp  

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