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.
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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. Groupon-type advertising is all the rage now but serious legal, ethical and contractual questions exist for medical and dental practices that need to be examined prior to entering into such arrangements. We have previously addressed this evolving issue in several articles on this website by evaluating some of the implications such arrangements have for providers. One of our articles was just published in the American Association of Oral and Maxillofacial Surgeons’ (AAOMS) bimonthly publication, Practice Management Notes. We are pleased to bring it to you here. 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 At a recent Health Care Fraud Prevention and Enforcement Action Team presentation given by the Office of Inspector General (OIG), the agency stressed the importance of documentation and identified the following seven common billing abuses performed by providers. 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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