Excluded Individuals Employed by Service Providers in Medicaid Managed Care Networks. Memorandum Report.

摘要

OIG is authorized to exclude certain individuals and entities (providers) from participating in federally funded health care programs, including Medicaid. Federal programs are prohibited from paying for any items or services furnished, ordered, or prescribed by an excluded provider. Managed care plans and their network providers may not employ or contract with an excluded individual to provide items or services paid for.by Medicaid. Nationally, approximately 70 percent of Medicaid beneficiaries receive some or all oftheir Medicaid services through managed care. To determine whether excluded providers are present in Medicaid managed care provider networks, 010 has conducted two evaluations; this is the second ofthe two evaluations. In the prior study, entitled Excluded Providers in Medicaid Managed Care.