Reasons why The OIG Exclusion List is Not Getting All State Exclusion Records

We all are well aware of the concept of What Is Exclusion Screening and their types. But, still there are some limitations out there. Like? Well, there is a lot of incomplete data is there on the OIG Exclusion List (LEIE). There are a number of reasons behind this. Some are simple whereas others are complex. The simple of them includes the typographical errors.

And some reasons are there because many State Medicaid offices is not even concern to report required information even when they are supposed to do as they are obligated under law.

This does not only affect the effectiveness of the OIG LEIE exclusion list but also fails in preventing unnecessary expense in the Medicare and Medicaid system.

Hence, it is clear that OIG LEIE is not getting all state exclusion records. Some of the typical reporting failures are depicted below:

• Untimely Reporting
• Finding Errors in Reporting
•  Finding a Path to Accuracy

Let’s dig in!

Untimely Reporting:

One state regulation should be applied to other states, according to 2011 ACA’s (Affordable Care Act) section 6501 regulations. In such case, a reliable resource with excluded individuals from all states is required by all the health organizations.

According to rule, State Medicaid offices were supposed to report the resource to OIG LEIE in a timely manner. But sadly, state Medicaid programs are failing in submitting the reports timely and even some of them are just fail to report anything at all.

Finding Errors in Reporting:

According to a report of 2015 OIG report, about 12 percent of providers who were reported as terminated for cause from State Medicaid programs continued participating in Medicaid in other States. From the year 2011 to 2014, the cost of participation by excluded providers was more than $7 million paid to 94 providers who were terminated for cause.

It was also observed that some names that qualified for listing on the exclusion list were not submitted.

Finding a Path to Accuracy

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