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States Fall Short on Medicaid Provider Credentialing, OIG Says

Washington -- Half the states in the U.S. aren't collecting pertinent Medicaid fee-for-service provider enrollment and credentialing information such as provider location information and previous Medicaid provider numbers, according to a new report.

The report from the Department of Health and Human Services' Office of Inspector General also found that 19 states don't contact sources to independently verify provider enrollment as required by the Health Care Financing Administration, and 17 states fail to gather provider information from external sources, such as Medicare carriers and fraud control units, regarding possible past investigations or prior practice patterns.

To remedy these problems, the OIG recommended the following: Medicaid enrollment procedures should mirror that of Medicare enrollment; states should independently verify a provider's exclusion status from federal programs; the Health Care Financing Administration should require states to obtain provider information from other states and federal entities; and HCFA should establish national standards similar to those used by Medicare for deactivating and reactivating Medicaid provider numbers.

HCFA agreed with the OIG's recommendations, but said it believes such improvements should be made by "working with and advising states, rather than adoption of additional stricter federal requirements."

For a complete copy of the report, go to http://www.hhs.gov/oig/oei/whatsnew.html on the Internet.

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