OIG puts providers on notice over exclusion from federal programs
OIG puts providers on notice over exclusion from federal programs
By MATTHEW HAY
HHBR Washington Correspondent
The Department of Health and Human Services’ (HHS; Washington) Office of Inspector General (OIG) released a special advisory bulletin Sept. 28 that puts home health agencies and other healthcare providers on notice about the effects of exclusion from federal healthcare programs and encourages them to take action to make sure they are in compliance with recently published regulations.
According to OIG spokeswoman Alwyn Cassil, the special advisory is primarily designed to answer a stream of questions posed to the OIG since it published the final rule. "We just published the regulations implementing that provision in July," she said, "and we have gotten a lot of questions about the effects of exclusion and what that means." She noted that both the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Balanced Budget Act of 1997 (BBA) expanded the OIG’s exclusion authorities. The bottom line, she said, is that no federal healthcare program payments may be made for any items or services furnished, directly or indirectly, by an excluded individual or entity.
Gabe Imperato, a healthcare attorney with Broad and Cassel in Fort Lauderdale, FL, agrees that the special advisory does not contain anything new. "It just compiles everything in one place and explains the OIG’s expanded authority under HIPAA and the BBA," he said. He added that providers should take note that the new rules expand the civil monetary penalty (CMP) and exclusion authority beyond programs just funded by HHS to all federal healthcare programs. He also noted a new CMP authorized by the statute that can be imposed against healthcare providers who employ or enter into contracts with excluded individuals.
Almost 17,000 individuals and entities have so far been excluded from participating in federal healthcare programs for misconduct ranging from fraud convictions to patient abuse to defaulting on health education loans, according to the OIG. The office expects to add another 3,000 individuals and entities to that list in FY99.
The special advisory is available on the Internet at www.hhs.gov/oig. Click on the "What’s New" link.
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