More and more public watchdog groups, press and user groups are finding holes in the system that may be of concern to those who are hiring or credentialing medical providers. The article dated June 30, 2014 from NPR demonstrates the complexities and timing issues. Some providers are able to circumvent the billing process and continue to receive payment for years after being acted upon by the various state medical boards. http://www.npr.org/blogs/health/2014/06/20/323889329/sanctions-common-against-doctors-with-odd-medicare-billing?ft=1&f=1001
Credit Reporting Agencies focusing on hiring, compliance groups and credentialing organizations have the mission to surface issues beyond just the exclusion data repositories like the Office of the Inspector General (OIG) or one of the many Federal sites that track violators. As you know, being excluded from the Federal Medicare process is only one element of the wider net that is needed to get all the data to make a hiring, risk or just plain due diligence decision.
The problem is often just timing. A scenario might be a provider is arrested for a crime and adjudication begins. Maybe a state medical board reviews the incident and takes action. The various states may jump into action and exclude the provider from receiving Medicaid payments which is administered from the states even though the money comes primarily from the Federal tax dollars. The license may be affected at the board level and it make take time to get into the exclusion process. Hearings have to be set and conclusions reviewed.
It is the due process that takes time and we all appreciate the need for it. But if you are a hiring entity or compliance group you may get caught in the cracks. The key is to check the various Federal, State and board actions that will blanket the whole process.
It is possible to get an accurate, up to date picture and TyphoonDATA has a solution with will cast a wide net, verify the false positives and close the cracks into a simple to use click process.