Department of Health and Human Services

Office of Inspector General -- AUDIT

"Medicare Payments to Excluded and Unlicensed Health Care Providers," (A-14-96-00202)

November 5, 1996

Complete Text of Report is available in PDF format (1M). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


This report provides the results of our review of Medicare payments to excluded and unlicensed health care providers. The objective of our review was to determine if the Medicare program inappropriately reimbursed individuals or entities who were excluded from the program or whose license was suspended or revoked by a State licensing board. Our review was limited to individuals and entities with a Maryland address at the time of exclusion and individuals whose license was suspended or revoked by the Maryland Board of Physician Quality Assurance.

We found:

Although nationally the percentage of aberrant health care providers (those excluded or with a suspended/revoked license) is small, they can endanger the lives of beneficiaries and should not be allowed to further abuse our health care system. We recommend that the Health Care Financing Administration (HCFA):

In response to our draft report, HCFA concurred with all of the recommendations.