Industry News

OIG Finds Excluded Individuals Employed by Medicaid Managed Care Entities

The Department of Health and Human Services Office of Inspector General (OIG) released a report concerning excluded individuals in Medicaid Managed Care Entities’ (MCEs’) provider networks. OIG reviewed a sample of MCEs’ provider networks with a total of 249,000 employees. OIG found that the MCEs employed 16 individuals who were on the OIG List of Excluded Individuals and Entities (LEIE). The individuals were excluded because their professional licenses were revoked, or for convictions related to health care fraud, patient neglect, or abuse.

The OIG determined that certain MCEs failed to discover employees’ exclusion statuses because employees supplied incorrect information on their employment applications. In some instances, staffing agencies failed to adequately screen prospective employees for exclusions before referring individuals to the MCE. OIG also found that seven percent of the sample provider networks failed to conduct sanction screening altogether. However, the OIG concluded that most MCEs successfully screen employees for exclusions.

The OIG report on excluded individuals employed by MCEs is available at:

Department of Health and Human Services Office of Inspector General. “Excluded Individuals Employed by Service Providers in Medicaid Managed Care Networks.” OEI-07-09-00632. 27 Sep. 2012.