Improper payments from the federal government to fraudulent providers is big business. In 2019, the estimated number of improper payments by Medicaid totaled $57.36 billion. The federal government has created guardrails to ensure that fraudulent providers and entities known to have perpetuated abuse do not receive payments.
One of the most significant tools for preventing these improper payments are exclusion lists. The Department of Health and Human Services Office of the Inspector General maintains the List of Excluded Individuals/Entities (LEIE) and the General Services Administration (GSA) maintains the Systems for Award Management (SAM). Both of these exclusion lists are publicly available for organizations to check against their providers, contractors, and vendors.
In addition to these federal databases, many states also maintain separate exclusion databases/lists for state Medicaid payments. Organizations have an obligation to check State Medicaid Exclusion databases in addition to their federal counterparts. These are the states with Medicaid exclusion databases:
What States have Separate Medicaid Exclusion Databases?
Checking each state for updated exclusion lists in addition to federal databases is an enormous task. These databases change regularly, and screening employees, contractors, and vendors once isn’t enough. Ongoing monitoring of your providers and entities helps to identify individuals who are ineligible to receive funds from the federal government thus mitigating improper payments under the Medicaid program.
Verisys provides our customers an online platform for health systems, hospitals, clinics, and other health care organizations to screen provider and entity populations and mitigate risk to their organization and patients.
Our clients use Verisys to complete end-to-end provider and entity credentialing, license verifications, background screenings, as well as continuous monitoring of provider exclusion data from thousands of primary sources. We monitor not only state and federal exclusion databases, but also thousands of other public and private databases to provide a complete picture of a provider’s background and history in an accessible, usable format.
|Written by Juliette Willard
Healthcare Communications Specialist
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