Free from Medicare Sanctions

  1. JOB REQUIREMENTS:

    Free from Medicare Sanctions (required)
    Current RN license (required)
    Current CPR (required)
    Adequate means of transportation to facilitate timely visits. (required)
    Minimum of two years experience as an RN, with one year in Home Health. (preferred)

    Above are job req for a HHC RN.
    What are MCA Sanctions???
    Why would a nurse be placed under MCA Sanctions????
    What are MCA Sanctions???

    I have never heard of this, have you? Please enlighten me.
    Thanks!
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  2. 5 Comments

  3. by   kids
    I dunno but I'd guess one would know if they had any, ya think?

    Wheres Hooli when we need her!
  4. by   RN2B2005
    Medicare sanctions are restrictions placed on your licence related to Medicare abuse or fraud. I believe that other circumstances can lead to sanctions, but the one I'm most familiar with is intentionally providing a false procedure code in order to obtain a higher rate of reimbursement. You would definitely know if you had any HCFA/Medicare sanctions. You wouldn't be able to work in any facility which accepted any form of HCFA/Medicare reimbursement.

    I've seen this in employment ads here in Seattle, too. I didn't think that sanctions were that common, but seeing it in ads kinda makes me wonder.
  5. by   rstewart
    Individual providers (for example nurses, physicians) as well as institutions/facilities (for ex Home Health agencies, Hospice etc) can be excluded from the Medicare and Medicaid programs. You can imagine what a big deal this is since so much of health care is paid for by these programs.

    Why are they sanctioned (punished) by the OIG? Simply put, they either abused/cheated the program (for example billed Medicare for services they didn't provide) or they abused/neglected patients in the program, or both.

    People who have sanctions know that they have them---except perhaps those whose sanctions had expired, but didn't realize that you have to reapply to become a provider again (ie if you are kicked out for 5 years you aren't really "legal" in 5 years automatically----you aren't legal again until they say you are.

    So if you are on the sanctions list you are going to have trouble finding work. And yes there really is a list....and the employer would be wise to check it rather than rely on the applicant's statements for obvious reasons.
  6. by   renerian
    If you do something wrong and are convicted of things like Medicare or Medicaid fraud you can be restricted where you are never allowed to work for someone who provides care to that type of client.

    renerian
    Last edit by renerian on Dec 13, '02
  7. by   NRSKarenRN
    Agree with all the above:

    In home care, we are required under Medicare regs to verify that a physician/provider has:

    a. a current active license
    b. no sanctions on license
    c. is not on Medicare/Medicaid exclusion list

    all before we even see the patient next day! We receive updates and run physician list 2x year in my offive to verify above. If on sanctions list cannot bill that progrm; can provide services to other insurance providers. All to prevent MC/MA fraud and abuse of system.



    More info:
    Testimony on Fraud in Medicare Programs by Michael F. Mangano
    Principal Deputy Inspector General
    U.S. Department of Health and Human Services
    http://www.hhs.gov/asl/testify/t970626b.html

    .....An OIG exclusion has national scope and is important to many institutional health care providers because the Congress of the United States established a Civil Monetary Penalty for institutions that knowingly hire excluded parties. Accordingly, the OIG maintains the List of Excluded Individuals/Entities (LEIE), a database which provides information to the public, health care providers, patients and others relating to parties excluded from participation in the Medicare, Medicaid and all Federal health care programs......
    http://www.oig.hhs.gov/fraud/exclusi...xclusions.html


    List of Excluded Individuals/Entities
    http://exclusions.oig.hhs.gov/

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