The Office of Inspector General (OIG) recently published a final rule that implements OIG’s expanded statutory exclusion authority. The final rule included a number of provisions that impact providers and suppliers.
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The Office of Inspector General (OIG) recently published a final rule that implements OIG’s expanded statutory exclusion authority. The final rule included a number of provisions that impact providers and suppliers. A recent report from the New Jersey Office of the State Comptroller indicates an expansion of the efforts of its Medicaid Fraud Division (MFD) to investigate fraud, waste and abuse in the New Jersey Medicaid Program. The report also highlights MFD’s expanded effort to exclude providers from the Medicaid Program. The government’s authority to exclude practitioners from participation in Federal health care programs has expanded dramatically since program exclusions upon conviction first began back in 1977. In an attempt to address industry questions about the scope of exclusion in today’s regulatory climate, the Office of the Inspector General (OIG) issued an updated Special Advisory bulletin this past May. Recently, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) calculated the savings its programs brought to the Federal government in 2011. The statistics, which reveal recoveries in the billions, serve as a sobering reminder to providers of the increasing interest by the government in ensuring that providers are complying with the healthcare laws and regulations. In our prior articles, we discussed the far reaching impact of an Office of Inspector General (OIG) exclusion from the Medicare Program on providers and suppliers. Exclusion from the Medicare Program also impacts employers and we address some of those ramifications below. In our prior articles, we looked at the basis for Medicare exclusion and how the Office of the Inspector General’s (OIG) powers to exclude providers has been recently enhanced by the passage of the Affordable Care Act. In this article we focus on the sweeping impact that exclusion has on providers and suppliers. The Office of the Inspector General (OIG) within the Department of Health and Human Services (HHS) has broad authority to take measures such as excluding providers and suppliers from participating in the Medicare Program in order to protect the program and beneficiaries. There are a number of reasons why exclusions may be imposed and we summarize them below. One of the most powerful tools the Office of Inspector General (OIG) within the Department of Health and Human Services has in safeguarding the integrity of the Medicare Program is the ability to exclude providers and suppliers from participation. It is the proverbial hammer that, when brought down, could severely hamper a physician’s ability to practice medicine and a healthcare facilities’ ability to stay operational. These days it seems like all aspects of a healthcare provider’s practice are under close scrutiny — including one’s repayment of student loans. Defaulting on a student loan may result in exclusion from the Medicare and Medicaid programs. The Office of Inspector General (OIG), a department within the U.S. Department of Health and Human Services In addition to any state laws that may impact a doctor’s practice, the main civil Federal laws and their implementing regulations that concern physicians are the False Claims Act, the Anti-Kickback Statute, the Physician Self Referral Act (often called the Stark Law), the Exclusion Statute, and the Civil Monetary Penalties Law. An additional law that |
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