Skip to HighlightsSkip to Recommendations
Pursuant to a congressional request, GAO reviewed the Department of Health and Human Services (HHS) Inspector General's (OIG) process for excluding providers from federal health care programs.
Recommendations for Executive Action
|Other||1. The HHS Inspector General should improve oversight of key state agencies that refers cases to the OIG, such as the state Medicaid agency and Medicaid fraud control unit, to ensure that states understand and comply with the statutory reporting requirements for state-removed providers.|
|Other||2. The HHS Inspector General should clarify to states that settlements and provider withdrawals to avoid formal sanctions should be reported to the OIG, in accordance with its regulations (42 C.F.R. 1001.601).|
|Other||3. The HHS Inspector General should provide ongoing, clear and consistent guidance to the states on the documentation needed for timely processing.|
|Other||4. The HHS Inspector General should establish consistent standards, performance goals or benchmarks, for the timely processing of state referrals.|
|Other||5. The HHS Inspector General should, in collaboration with the Health Care Financing Administration, transmit OIG exclusion data either electronically or by diskette, including social security numbers, to state Medicaid agency officials responsible for enrolling and removing providers.|