| NCJ Number: |
169188   |
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| Title: |
Medicaid Fraud and Abuse: Stronger Action Needed To Remove Excluded Providers From Federal Health Programs |
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| Corporate Author: |
US Government Accountability Office
Health, Education, and Human Services Division
United States of America |
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| Date Published: |
1997 |
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| Page Count: |
39 |
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| Sponsoring Agency: |
Azimuth Inc.
Fairmont, WV 26554
NCJRS Photocopy Services
Rockville, MD 20849-6000
US Government Accountability Office
Washington, DC 20548 |
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| Publication Number: |
GAO/HEHS-97-63 |
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| Sale Source: |
Azimuth Inc.
1000 Technology Drive, Suite 3120
Fairmont, WV 26554
United States of America
NCJRS Photocopy Services
Box 6000
Rockville, MD 20849-6000
United States of America |
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| Type: |
Survey |
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| Language: |
English |
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| Country: |
United States of America |
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| 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. |
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| 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 |
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| Main Term(s): |
Criminology |
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| Index Term(s): |
Fraud and abuse prevention measures; Interagency cooperation; Intergovernmental relations; Medicaid/Medicare fraud; Medical fraud; Regulations compliance; US Department of Health and Human Services |
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To cite this abstract, use the following link:
http://www.ncjrs.gov/App/publications/abstract.aspx?ID=169188 |
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