AGG Healthcare partner David Blank was quoted in a Kaiser Health News article diving into the publication’s monthslong investigation uncovering the gaps in federal oversight that allow people who have been legally banned from billing Medicaid, Medicare, and other taxpayer-funded federal health programs to once again tap into payments.
The government relies on those who are banned to self-report their infractions or criminal histories on federal and state applications when they move into new jobs or launch companies that access federal healthcare dollars. Although the Office of Inspector General for the U.S. Department of Health and Human Services keeps a public list of those barred from receiving payment from its programs, little is done to track those who are excluded.
While large hospital systems and clinics employ compliance staff or hire contractors who screen their workers against the federal list to avoid fines, those who own or operate healthcare businesses are usually not subject to such oversight. Individuals often sidestep detection by leaving their names off key documents or using aliases.
“If you intend to violate your exclusion, the exclusion list is not an effective deterrent,” David explained to KHN. “There are too many workarounds.”
David added that the exclusions list is meant to easily identify a person as someone who cannot be trusted to handle public healthcare dollars. However, only certain types of felonies disqualify people from accessing federal healthcare money and the system relies on felons to self-report.
To read the full article in KHN, please click here. The article was also published by USA Today (subscription required).