OIG Expands Its Ability to Exclude Individuals or Entities from Participating in Federal Healthcare Programs

January 27, 2017 | Aging Services Risk, Quality, & Safety Guidance

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​A final rule published by the U.S. Department of Health and Human Services' Office of Inspector General (OIG) in the January 12, 2017, Federal Register codified OIG's expanded authority to exclude individuals or entities from participating in federal healthcare programs. The rule includes changes made in accordance with the amended Patient Protection and Affordable Care Act and the Medicare Prescription Drug, Improvement, and Modernization Act. Under the final rule, OIG may permissively exclude individuals or entities convicted of interference with or obstruction of any investigation or audit related to "the use of funds received, directly or indirectly, from any federal health care program" and certain other offenses. OIG previously had the authority to permissively exclude individuals or entities that furnished or ordered covered services or items but failed to provide certain payment information. With the final rule, OIG can also permissively exclude individuals or entities that refer patients for or certify the need for items or services and fail to provide required payment information.

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