Ohio Medicaid Provider Exclusion and Suspension List

Posted by Frank Strafford on February 18, 2016 in Background Screening, Exclusion Screening, Exclusions,

Ohio Medicaid Provider Exclusion and Suspension List

Ohio Medicaid Provider Exclusion and Suspension List

The Ohio Department of Medicaid (ODM) was founded in July 2013. It is the premier Executive-level Medicaid agency of the state of Ohio. Led by Director John B. McCarthy and in partnership with the Governor’s Office of Health Transformation, the ODM provides health care coverage to 2.9 million residents daily, through 83,000 providers.

Through the Ohio Revised Code, the Ohio Department of Medicaid has been granted rule-making authority which covers:

1.) Adoption of new rules.

2.) Amendment/Repealing of current rules.

These rules are accessible here: Medicaid Program Rules, Section 5160

One of ODM’s core commitments is to provide Ohio’s families and taxpayers with healthcare service of utmost efficiency and transparency through, among other things, a relentless fight against healthcare fraud.

Although the Ohio Department of Medicaid regularly updates its own list of suspended individuals/entities, which is accessible via this link: Ohio Medicaid Provider Exclusion Suspension List (Updated 2/12/2016), it nonetheless urges providers to conduct database searches using these sources:

Questions related to Medicaid program exclusions and suspensions may be addressed to: [email protected]  State “Exclusions” in the subject line and include the individual’s full name (including middle initial) and the last four digits of their Social Security number.

Some stats from the LEIE regarding Ohio.

  • 160 Number of exclusions in 2015 in the state of Ohio
  • 748 – Number of exclusions in Ohio from years 2010-2014
  • among the exclusions 2015 in Ohio are nurse/nurse aide, healthcare aide, pain management, home health agency, internal medicine, transportation co, OB/GYN, Podiatry & more.
  • Exclusions handed out during 2015 in Ohio include but not limited to:
    • Conviction of program-related crimes 1,102
    • License revocation or suspension 493
    • Conviction relating to patient abuse or neglect 304
    • Felony conviction relating to healthcare fraud 253
    • Felony conviction relating to controlled substance 136

To learn more about LEIE stats see our infographic

LEIE national statistics

 

Sources:

https://medicaid.ohio.gov/RESOURCES/Legal-and-Contracts/Rules

http://medicaid.ohio.gov/PROVIDERS/EnrollmentandSupport/ProviderExclusionandSuspensionList.aspx

https://medicaid.ohio.gov/MEDICAID-101/About-Us

http://oig.hhs.gov/exclusions/exclusions_list.asp

https://oig.hhs.gov/exclusions/authorities.asp

To learn more about State Medicaid compliance, visit our MEDICAID EXCLUSION LIST page.

About Frank Strafford

About Frank Strafford

Related Articles

Florida – A Hotbed for Medicaid Fraud

July 26, 2016

Florida Medicaid Fraud   Medicaid fraud in Florida results in losses of more than 6 billion dollars each year. Such is the state’s reputation for being a hotspot for this kind of fraud that Nigeri...

Arizona Medicaid Exclusion

September 14, 2016

Arizona Exclusion The Arizona Health Care Cost Containment System (AHCCCS) Office of Inspector General takes on the task of safeguarding the state’s Medicaid Program which amounts to $9 billion. Its...

What’s New In The OIG 2015 ...

January 7, 2015

Have you reviewed the 2015 Work Plan yet to see how it may affect you?                                                                       Although there haven't ...

Understanding OIG Exclusions

OIG Exclusions Screening Process

Exclusion FAQS

Quick OIG Exclusion Basics

Employing Excluded Individuals

Consequences to Employing an Excluded Individual

OIG Compliance Law

Laws and Publications on OIG Compliance

More Compliance Resources

The Verify Way!

We build the best, so you can perform at your best.

Trusted for Good Reason

  • ✓ Guaranteed accurate
  • ✓ Certified Secure
  • ✓ Audit Proof
  • ✓ Feature-rich reporting
  • ✓ Round the clock real-time-data
  • ✓ Processing fully automated

Security First

  • ✓ Cloud hosted
  • ✓ Encrypted data
  • ✓ Real-time backups

Trusted for Accuracy

  • ✓ Physical security
  • ✓ Restricted access
  • ✓ Single sign-on
  • ✓ Password security
  • ✓ Certified secure
  • ✓ Cross checking

HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY

5

60%

Average workload reduction by implementing the Streamline Verify program

5

10K

Establishments trust Streamline Verify nationwide

5

2011

Serving the healthcare industry’s unique compliance needs since 2011

5

24X

Setting standards with hourly synchronization to primary source data

[class^="wpforms-"]
[class^="wpforms-"]