OIG Providers Exclusion Database is a vital tool in protecting Texans

One way the OIG protects the health and welfare of people receiving Medicaid is by preventing certain people or businesses from participating as service providers. Medicaid providers are responsible for making sure they don’t employ or contract with someone listed on the state or federal OIG exclusion lists. The requirements apply to both health care practitioners and other employees, such as clerical staff.

Federal and state OIGs may prohibit people or businesses from participating as Medicaid providers for several reasons, including Medicaid fraud convictions, patient abuse, billing for false claims, illegal Medicaid client solicitation or offering kickbacks in exchange for business, Medicare program exclusion, and licensing issues. In fiscal year 2022, there were 174 exclusions from participation in Texas HHS programs.

The consequences of exclusion

When a person or entity is excluded from Medicaid or other HHS programs, they may not request or receive payment for providing goods or services performed under Medicaid or any other HHS program. Excluded physicians may not provide care or prescribe services to HHS program recipients. A physician employing an excluded person may not bill Medicaid or any other HHS program for the excluded employee’s services. Submitting claims for payment involving an excluded employee’s services could result in recoupment of paid claims or an amount corresponding to a portion of the ineligible employee’s salary and benefits, program termination, program exclusion, or monetary penalties.

An employer’s responsibility

Providers are required to screen all employees for exclusion from Medicaid on a monthly basis. Under the OIG’s rules, a practice may be subject to administrative sanctions for failing to document that its employees or contractors are not excluded, or for failing to notify OIG after identifying an excluded employee. The Texas Exclusions List is updated daily. You can access the state list via the Texas OIG website, ReportTexasFraud.com. The federal list and an instructional video for using it are available at exclusions.oig.hhs.gov.