Fraud-prone providers slipping into states' Medicaid programs, OIG says

Some state aren't properly screening Medicaid providers who are at high risk for fraud, waste and abuse, according to a report from HHS' Office of Inspector General.

A survey found 18 states had failed to implement a fingerprint-based criminal background check for Medicaid providers prone to fraud before a July 2018 deadline. At the start of 2019, 13 of the 18 states still had not implemented these checks.

OIG said "unscrupulous providers" could have entered states' Medicaid programs through two loopholes in the provider enrollment process. "If not all high-risk providers undergo criminal background checks, the Federal and State Governments are vulnerable to unscrupulous providers intent on defrauding the Medicaid program," the agency said.

OIG recommended that CMS enact multiple steps to ensure all states use fingerprint-based criminal background checks when enrolling Medicaid providers. 

Read the full report here.

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