Since the Affordable Care Act was passed in 2010, there has been a pronounced crackdown on health care-related fraud. Why, then, have revoked/terminated providers managed to slip through the cracks and are still taking advantage of Federal health care programs?
To illustrate: around this time last year, the OIG submitted a review on the Ohio State Medicaid Fraud Unit. This was done in compliance with Federal grant requirements to assess the unit’s performance. The OIG used seven sources to analyze data for the Ohio unit:
A review of FY 2011-2013 files including policies, procedures, and documentation of the unit’s staffing, operation, and caseload;
A review of FY 2011-2013 financial documentation;
Structured interviews with key stakeholders;
Survey of the unit’s staff;
Structured interview with the unit’s management;
Onsite review of FY 2011-2013 sample of file for open cases;
Onsite observation of the unit’s operations.
The OIG discovered were 403 reported criminal convictions and recoveries of around $214 million for the abovementioned FYs. However, the Ohio unit did not submit these reports within the OIG exclusion timeframe. For exclusion purposes from Federal health care programs, the OIG strongly endorses the submission of reports well within the given deadlines.
Hundreds of millions of dollars in expansion for Medicaid must be used properly, not abused by the wrong people. Submitting the exclusion reports in a timely manner and in accordance with OIG recommendations cannot be emphasized enough.