Effects Of Oig Exclusion On Health Care Professionals

1328 Words Jun 20th, 2016 6 Pages
The Effect of OIG Exclusion On Health Care Professionals.

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Pursuant to sections 1128 and 1156 of the Social Security Act, the OIG has the authority to exclude individuals and entities from Federally funded health care programs, like Medicare and Medicaid. The paramount effect of exclusion is that payment is prohibited for items or services that an excluded individual or entity provides. This prohibition extends to anyone who chooses to employ or contract with an excluded individual or entity. Providers who violate this prohibition, are required to pay back any and all Federal funds inappropriately received and may also be subject to civil monetary penalties (“CMP”).

The Two Types of Exclusions: Mandatory and Permissive.

1. Mandatory exclusions.

OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.

2. Permissive exclusions.

The OIG has discretion…
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