• Information on Florida's Medicaid sanction lists for fraudulent providers is readily available.Hospital image by Raulmah?3n from Fotolia.com
  
  Florida Medicaid is a state and federal health care program providing care to low-income individuals. The program is large with roughly $18 billion in expenditures covering more than2.7 million Florida residents. A major aspect of program management is combating fraud and abuse within the program. To further this effort the Florida Agency for Health Care Administration operates anti-fraud programs that includes publication of a Medicaid provider sanction list.
  
  

Recent Federal Activity

• In 2009, the Centers for Medicare and Medicaid (CMS) issued a letter to state medical directors emphasizing the importance (and consequences) of making payments to excluded individuals and entities. It should be noted that in the past, Medicare and Medicaid paid claims first, and subsequently investigated. This policy has changed to one of denying payments where fraud is suspected. As part of this effort, CMS is requiring states to screen providers and employees on a periodic basis for purposes of exclusion.
  
  

Sanctions List

• Health and Human Services, Office of the Inspector General (HHS-OIG) has the power to exclude participants in all federal health care programs as defined in Section 1128B9f) of the Social Security Act. As this applies to all federal health care programs, CMS requires states reference the List of Excluded Individuals/Entities (LEIE) to determine whether a potential payment is about to be made to an employee or contractor previously excluded from participation in the program. The LEIE is a publicly accessible database of excluded providers.
  
  Note the exclusion includes services and equipment, and extends to situations where the provider should have known of her excluded status. Finally, payments may not be made to managed care organizations contracted with an excluded party.
  
  States are required to determine whether an entity contains an excluded element. In addition to the LEIE, CMS created the Medicare Exclusion Database (MED) as an additional resource for states to make exclusion determinations. States are required to report exclusion determinations to the HHS-OIG under 42 CFR 1002.3(b)(3). Finally, HHS-OIG provides monthly updates on exclusion and reinstatement information for state payment purposes.
  
  

Consequences for Payments to a Sanctioned Entity

• The federal government is prohibited from making payments to sanctioned entities on the LEIE and MED, therefore if a state makes a Medicaid payment to a sanctioned entity, the state will not receive the federal payment portion for such services. Any payments made or claimed will constitute an overpayment, which may be recouped.