Medical professionals often rely on payments from Medicare for services provided to patients. The United States Department of Health and Human Service’s Centers for Medicare and Medicaid Services administers this program and requires medical professionals meet certain criteria to receive payment. In some situations, the government can choose to exclude a professional’s ability to request payments.
Such action is not uncommon and can cripple a medical facility. A recent report by LoHud found 230 medical professionals from Westchester and Rockland counties alone had lost this privilege.
How does a medical professional loose the privilege to receive payment from Medicaid? The government has come down on any medical professional that could be prescribing opioids unwisely. As such, this is one common way to lose the privilege. Additional examples include:
- Program related crimes. Another example involved a substance abuse treatment center. The government accused the center of filing claims for excessive services and running a treatment center that lacked proper regulation of residential treatment services. The owner of the center received a minimum of five-year exclusion from Medicare.
- Theft. The government also accused some of stealing from patients. One specific example involved a woman at a nursing home who was accused of stealing from residents. The woman oversaw a trust fund maintained by residents. She was accused of drawing checks for residents who had not requested the funds and keeping the money for herself.
- Abuse and neglect. Government accusations to support the exclusion of payment also include abuse and neglect of patients. The government charged one woman working in a group home of abuse for failing to properly report an injury to a woman under her care. In addition to a suspension from Medicare, the woman also received a sentence of five years’ probation.
These are just a few examples of the many different means the government uses to exclude medical professionals from receiving payment from the Medicaid payment.
How can medical professionals avoid exclusion? The exclusion is generally proceeded by an investigation. As such, anyone that is the subject of an investigation is wise to seek legal counsel to reduce the risk of losing the ability to receive payment for services through Medicare.