OIG Exclusion Changes

Recently the Health and Human Services Office of the Inspector General requested changes in their sanction regulations based on recent events. The new rules are designed to strengthen the OIG authority to exclude providers from federal healthcare programs and a copy of these rules may be seen at http://oig.hhs.gov/authorities/docs/2014/2014-10390.pdf. The new rules provided under the Affordable Care Act (ACA) include exclusions for: • Conviction of an offense in connection with Obstruction of an audit; • Failure to supply payment information (ACA expanded this provision to apply to individuals who ‘‘order, refer for furnishing, or certify the need for’’ items or services for which payment may be made under Medicare or any State health care program); and • Making, or causing to be made, any false statement, omission, or misrepresentation of a material fact in applications to participate as a provider of services or supplier under a Federal health care program. Most first time exclusions have a three year exclusion from any Federal Program plus a significant monetary fine. Regardless of changes effected in the rules by the ACA healthcare professionals and organizations should keep track of the OIG, their rules and activities to ensure that their operations are in order and avoid possible mishaps.