Doctors' Disorders


A recent government investigation into the nation's health program for the poor has found that medical providers guilty of "fraud or patient abuse or neglect" continue to participate in Medicaid and other federally funded health programs. Although Medicaid–which spent over $159 billion in state and federal money during fiscal 1995–is administered by individual states, the U.S. Department of Health and Human Services is responsible for determining which doctors, hospitals, pharmacies, and other medical institutions are excluded from the program.

Last fall, the General Accounting Office looked at exclusion processes in Illinois, Maryland, Missouri, Virginia, and the District of Columbia. The GAO found that HHS had failed to act promptly, even in cases where providers had been convicted of or admitted to fraud or other malfeasance. Investigators also found "inconsistencies" among HHS field offices regarding which providers would be considered for exclusion.

In one case, the GAO's Leslie G. Aronovitz testified before Congress last fall, it took the Chicago HHS office more than a year to forward exclusion paperwork on a pharmacy that had overbilled Illinois's Medicaid by over $117,000. In another case, a field office recommended a provider be excluded 19 months after learning that the provider had pled guilty to false billing in state court.

Worse still, said Aronovitz, due to a lack of case file documentation at the HHS field offices, investigators could not even determine the "magnitude and pervasiveness of the problems in the exclusion process."