2016 OIG Work Plan: State Medicaid Agencies Must Comply with Exclusion Rules

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2016 OIG work plan

The Office of Inspector General’s 2016 OIG Work Plan contains two important projects that focus on the enforcement of exclusion rules by States and their Medicaid Fraud Control Units. Viewed in the context of the creation of a special task force in June of 2015, and other data we have cited to in the past year, it is clear that enforcement of exclusion rules and exclusion violations remain a priority for the agency.

I. The Projects of 2016 OIG Work Plan

In the first project, the OIG announced that it will determine the extent to which States are collecting the required ownership information in compliance with Federal and State regulations and whether States are verifying the information it receives by checking exclusion databases as they are required to do. In a separate study, the OIG will evaluate compliance with ACA, §6402 and consider whether States are conducting the required enhanced screenings for moderate and high-risk providers, and whether they are revalidating these Medicaid providers and suppliers as the act requires.

II. Significance of 2016 OIG Work Plan Projects

These studies are significant because many States, such as Texas and Louisiana, have expanded their disclosure provisions well beyond owners to include all employees, vendors and contractors. These disclosure provisions typically include information on exclusions, suspensions and other adverse actions. Thus, in many states, in order to be in compliance with their enrollment agreement, providers will have to screen all employees, vendors and contractors with all State databases in addition to the LEIE and their own State!

III. Conclusion

We will monitor these projects and report on them upon completion. In conclusion, regardless of the level of enforcement, there are too many good reasons for a provider not to have a robust exclusion program.

2016 OIG Work Plan

Paul Weidenfeld, Co-Founder and CEO of Exclusion Screening, LLC, is the author of this article. He is a longtime health care lawyer whose practice has focused on False Claims Act cases and health care fraud matters generally. Contact Paul should you have any  questions at: pweidenfeld@exclusionscreening.com or 1-800-294-0952.

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