OIG puts providers on notice over exclusions

The Health and Human Services' (HHS) Office of Inspector General (OIG) released a special advisory bulletin Sept. 28 that outlines the effects of exclusion from federal health care programs. The purpose of the advisory, says OIG spokeswoman Alwyn Cassil, is to encourage the health care industry to take action to make sure it’s in compliance with recently published regulations.

"We just published the regulations implementing that provision in July," she says, "and have gotten a lot of questions about the effects of exclusion and what that means." Cassil notes that both the Health Insurance Portability and Accountability Act of 1996 and the Balanced Budget Act of 1997 expanded the OIG's exclusion authorities. The bottom line is that no federal health care program payments may be made for any items or services furnished by an excluded provider.

Gabe Imperato, a health care attorney with Broad & Cassel in Fort Lauderdale, FL, says providers should note that the new rules expand the civil monetary penalty (CMP) and exclusion authority beyond programs funded by HHS to all federal health care programs. He says a new CMP authorized by the statute can be imposed against health care providers who employ or enter into contracts with excluded individuals.

About 17,000 providers have been excluded from participating in federal health care programs for misconduct ranging from fraud convictions to patient abuse to defaulting on health education loans. The OIG expects to add another 3,000 individuals and entities to that list in FY ’99.

The bulletin is available at www.hhs.gov/oig. Click on the "What's New" link.