HHS Expands Ability to Ban Medicare, Medicaid Providers

Providers who obstruct government audits or fail to provide investigators with prompt access to medical records can face exclusion from Medicare and Medicaid.

Exclusion from the federal health programs can be a death sentence for providers who rely on claims payments to stay in business. The exclusion expansion may heighten provider risk.

The exclusion expansion was part of a final rule from the Health and Human Services Office of Inspector General released Jan. 11. The final rule was published in the Federal Register Jan. 12 (82 Fed. Reg. 4,100) and is effective Feb. 13.

The final rule complements a December 2016 OIG final rule that expanded the use of civil monetary penalties for violations such as physicians making false statements when enrolling in federal health-care programs.

The OIG also expanded its exclusion authority to include banning providers from Medicare and Medicaid if they're convicted of illegally prescribing or distributing a controlled substance and failing to provide payment information to the OIG.

Under the final rule, organizations can be excluded from Medicare and Medicaid if they have direct or indirect ownership relationships with individuals who have been convicted of criminal offenses.

10-Year Limit

The final rule also limits the OIG to a 10-year period to pursue exclusions. The earlier proposed rule didn't include a limit.

The OIG said the 10-year limit would allow for necessary exclusions while easing administrative burdens on Medicare and Medicaid providers.

(Source:  Bloomberg News 1/12/2017)