OIG Issues Update on Effects of Exclusion from Federal Healthcare Programs

May 24, 2013 | Aging Services Risk, Quality, & Safety Guidance

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​An updated Special Advisory Bulletin from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued May 8, 2013, explains that payment from any federal healthcare program will not be forthcoming for “items or services furnished (1) by an excluded person or (2) at the medical direction or on the prescription of an excluded person.” This update also clarifies the repercussions of a violation of exclusion: “For example, no payment may be made to a hospital for the items or services furnished by an excluded nurse to Federal health care program beneficiaries, even if the nurse’s services are not separately billed and are paid for as part of a Medicare diagnosis-related group payment received by the hospital. Also, the excluded nurse would be in violation of her exclusion for causing a claim to be submitted by the hospital for items or services the nurse furnished while excluded,” OIG explains. The exclusion is violated even if the excluded care provider is furnishing items or services not for direct patient care.

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