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Banned from Medicare but billing Medicaid

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“Card-sharpers by Candlelight,” by Feliks Peczarski.

Reuters notes that  the Affordable Care Act “explicitly requires that states suspend the billing privileges of most providers who have been ‘terminated’ or ‘revoked’ by another state or Medicare.

“But in an exclusive analysis of state and federal data, Reuters found that more than one in five of the thousands of doctors and other healthcare providers in the U.S. prohibited  {for various infractions] from billing Medicare are still able to bill state Medicaid programs.”

With millions of patients newly covered by Medicaid under the ACA, and wild differences in the program’s oversight between states, it’s hard to see how this problem won’t get worse.

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