It should come as no surprise that a Health Compliance and Ethics officer is one of the more stressful positions in the modern day business world. The job comes with a tremendous responsibility and a negligent move on their part can mean huge losses of money to the organization and compromise the health and even life of many patients.  According to a survey by the Society of Corporate Compliance and Ethics  (SCCE) and the Health Care Compliance Association (HCCA) nearly 3 out of 5 compliance officers say they often wake up in the middle of the night due to worrying about job related circumstances.

Among the extensive amount of duties compliance officers are charged with, is exclusion screenings: to ensure that all employees and providers are not deemed ineligible to treat medicaid and medicare patients as indicated on the database lists which are updated monthly by federal and state agencies.

Some state database lists are easier to check than others.  One of the most difficult state databases is Florida.  The reason being is that the state of Florida doesn’t only include on their exclusion list those providers that are only terminated or suspended but must include as well those providers that have monetary sanctions and charged with a final order type of either fine or corrective action plans as a result of a statutory provision passed in 2009 .  This makes the exclusion screening for Florida all the more complicated since a provider can still be eligible even though they are listed in the database as a result of monetary sanctions against them.  

Many compliance officers use the AHCA web portal to download the different databases available in order to check if the respective provider is listed on these lists.  Firstly, this can be time consuming as there are numerous categories of final orders that need to be checked. More importantly, these lists do not tell you conclusively if the provider is still eligible.  Providers may still be suspended or terminated for other reasons and by other means that did not involve a final order.

In an effort to alleviate some of that everyday stress in the life of a compliance officer we would like to share a resource that clarifies conclusively if a provider is deemed ineligible to provide services.

On the Florida Medicaid Web Portal you are able to access the Provider Master List.  Under the Managed Care menu, you will want to select Provider Master List, which can be found under the Registration column (third from the right). You will then need to select the Provider Master List spreadsheet link in the “Provider Information Reports” section, and unzip the Excel file. Providers that have an E listed next to their Medicaid IDs/names are considered by AHCA to be ineligible to provide services.

It is our hope that this resource will help streamline the compliance process and give some well deserved relief…

Check out this great resource for all questions on the Florida OIG Exclusion List.