CMS Failed to Report Providers' Adverse Actions, Says OIG

Cheryl Clark, for HealthLeaders Media , September 23, 2010

CMS imposed civil monetary penalties and terminations against managed care and prescription drug plans that fail to comply with Medicare requirements, but failed to report 30 adverse actions it took against those entities between Jan. 1, 2006 to July 31, 2009.

Such adverse events that should have been reported include:

  • Any loss, revocation or suspension of a license or certification agreement or contract for participation in a federal or state healthcare program
  • Any loss of the right to apply for or renew a license, certification or agreement or contract.
  • Any reprimand, censure or probation
  • Any other negative action or finding by a federal or state agency that is publicly available, including limitations on scope of practice, liquidations, injunctions, exclusions, revocations, suspensions or forfeitures.
  • The conviction or fining of a mental health institution for condoning physically abusive methods of controlling patients.
  • The conviction or fining of a chiropractor and a medical supply company for providing kickbacks in exchange for patient referrals
  • The deferred conviction of a practitioner for accepting money for referrals to a specialist and sentencing of the practitioner for a 2-year probationary period.
  • A civil judgmeent against a physician for medical malpractice resulting in an award to the plaintiff
  • A deferred conviction of a practitioner for possession and abuse of drugs and sending the practitioner to a rehabilitation facility.
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