The South Carolina Department of Health and Human Services has distributed a reminder to Medicaid providers concerning their obligations to check eligibility of your physicians, employees and contractors who may be receiving Medicaid, SCHIP, and Medicare reimbursement. Physicians and practices do need to pay attention to your obligations for verifying eligibility for participating in any of these government programs.
The Centers for Medicare and Medicaid Services (CMS), in a State Medicaid Directors Letter dated January 16, 2009 (SMDL #09-001), informed States of their obligation to direct providers to screen their own employees and contractors for excluded persons. Under federal law, health care programs such as Medicaid, the State Children’s Health Insurance Program (SCHIP) and Medicare cannot pay for services or items furnished, ordered, or prescribed by an excluded health care provider. The South Carolina Department of Health and Human Services (SCDHHS) has several processes in place to ensure that it identifies excluded providers and also denies their payment.
The bulletin from Medicaid has been added to the SCOA Blog in its entirety, http://blog.scoanet.org/. The bulletin will help clarify the SCDHHS process and provide guidance to Medicaid providers regarding their own compliance with exclusion rules.
The HHS-OIG maintains the LEIE (List of Excluded Individuals and Entities), a database accessible to the general public that provides information about parties excluded from Medicare, Medicaid, and all other Federal health care programs. The LEIE website is located at http://www.oig.hhs.gov/fraud/exclusion.asp and is available in two formats. The on-line search engine identifies currently excluded individuals or entities. When a match is identified, it is possible for the searcher to verify the accuracy of the match by entering the Social Security Number (SSN) or Employer Identification Number (EIN). The downloadable version of the database may be compared against an existing database maintained by the provider; however, the downloadable version does not contain SSNs or EINs.
The SCDHHS website can be located at www.scdhhs.gov, and the link to the list of excluded South Carolina providers is under the “Provider” box that appears on the home page. The SCDHHS list includes only South Carolina Medicaid providers (or those with a South Carolina connection) and does include an NPI for any provider that has one.
Download Provider Exclusion Bulletin Final
