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Many banned Medicaid providers work in other states

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A federal auditor reports that undreds of medical providers banned from a Medicaid program in one state have been able to participate in another state’s program despite regulations designed to stop them. This leaves Medicaid programs more open to fraud, waste and other abuse.

Reuters reported that investigators, working for  the U.S. Department of Health and Human Services Office of the Inspector General (OIG), “also found that about half of the states were unable to terminate providers enrolled in privately run Medicaid managed care programs. Some refuse to terminate providers still licensed by a medical board, {investigators} found.”

“If a provider has been terminated by a state, that is a red flag, because it would indicate there was a problem either in billing or the way they handle patients,” said Deborah Cosimo, team leader for the report. “Do states really want to trust beneficiary care to someone who has problems like that?”

“The latest report may underestimate the number of providers who continue to participate in Medicaid after termination and the amount they were paid due to poor record keeping by the states, the auditor wrote.”



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