People are tapping into Medicaid, Medicare and other taxpayer-funded federal health programs after being legally banned because of fraudulent or illegal behavior. And the federal system meant to stop them is not working, an investigation finds.
, an attorney with the firm Paul Hastings who had prosecuted Peterson while working for the OIG, said the agency has limited resources. “There are so many people on the exclusions list that to proactively monitor them is fairly difficult.”
But the government relies on people to self-report that they are banned when applying for permission to file claims that access federal health care dollars through the Centers for Medicare & Medicaid Services. Gaps in reporting also mean many who are barred may not know they could be violating their ban because exclusion letters can go out months after convictions or settlements and may never reach a person who is in jail or has moved, experts said. The exclusion applies to federal programs, so a person could work in health care by accepting only patients who pay cash or have private insurance.
The NPI should be “essentially wiped clean” when the person is excluded, precluding them from submitting a bill, saida former assistant chief for health care fraud at the Department of Justice who is now a partner for the law firm Barnes & Thornburg.
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