3 Doctors Who Demonstrate the Necessity of the Medicaid and Medicare Exclusion Databases

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If you’ve ever had to deal with the Medicaid and Medicare exclusion databases in order to meet the requirements of the Office of the Inspector General, or if you’re responsible for hospital screening or nursing home compliance programs, the recent aggressive moves on the part of Health and Human Services might seem excessive. In just the first two months of 2015, there have been hundreds of thousands of dollars of fines imposed on healthcare providers that hired excluded individuals.

Fear of getting fined is one reason to perform regular hiring checks against the OIG list of excluded individuals. But if you’re getting frustrated with the process, it might also help to remind yourself why some people end up on the OIG list of excluded individuals, and how it is that Medicaid and Medicare exclusion database checks protect patient safety. Here are three incidents from February alone that serve as good reminders of why exclusion is necessary:

  1. Fake Doctor Costs Medicare $8.5 Million

    Alejandra Collazo allegedly posed as a doctor, nurse and nurse practitioner in Florida over the course of several years, using stolen identities and writing over 2,000 false referrals to home care services that repaid her for the business. She apparently cost the federal Medicare program $8.5 million with her scam.

  2. Doctor Accused of Dealing, Trading Drugs

    John Ronald Verbovsky, a Michigan-based osteopathic physician, has been charged with more than 10 felonies, including racketeering, drug dealing, sexual misconduct and Medicaid fraud. Investigators are claiming that he prescribed narcotics to patients who promised him money or sex in return.

  3. Doctor Caught in Sex Sting Operation

    Donald W. Lamoureaux, a family physician, was arrested in Missouri and has been charged with both online enticement of a minor and traveling to meet a minor. He began talking online with a woman who claimed to be a single mother who was willing to let him engage in sexual activities with her 4-year-old daughter; the woman was actually an undercover officer.

Of course, many of the actions that land people on the exclusion list are more mundane than these, but it’s a good reminder of why the exclusion list exists. Share your reaction in the comments.

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