Texas dentist permanently excluded from Medicaid
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. Someone can be added to the Texas Exclusions List for several reasons, including Medicaid fraud convictions, patient abuse, Medicare program exclusion, or licensing issues with any licensing boards for health care practitioners.
For example, a Texas dentist was permanently excluded from Medicaid participation in the third quarter. In a contested hearing, the OIG presented evidence that the dentist failed to comply with health care standards, submitted multiple false claims for reimbursement for dental work not performed, misrepresented and omitted information on his Texas Medicaid enrollment application and failed to maintain required documentation. The administrative law judge agreed to the permanent exclusion from Medicaid.
In April, an occupational therapy assistant (OTA) was excluded from Medicaid participation for ten years. The OTA falsified billing records, causing the employer to bill for services which were not rendered. A patient’s family verified that not only did the OTA falsify the time records, but also falsified some of the signatures on the time records. The OTA’s employer paid back $35,720 in payments and reported the OTA to the OIG. The employer fully cooperated, and with their assistance, the OIG was able to exclude this OTA for ten years.
Medicaid providers are responsible for making sure they don’t employ anyone listed on the Texas or Federal HHS OIG Exclusion Lists. A person or entity hiring anyone on the exclusion lists could be subject to recoupment of any compensation paid to the ineligible worker, or to sanctions, including termination, exclusion, or penalties.