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Exclusion Regulations for Federal Healthcare Programs to Expand Under OIG Final Rule

The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) will this month implement its final rule for exclusion of individuals and entities from participation in federal healthcare programs. These changes will be included under section 1128 of the Social Security Act and will broaden the power of the OIG to make such exclusions.

Perhaps the most significant expansion is the OIG’s increased ability to use its permissive exclusion authority. The final rule expands permissive exclusions for convictions related to obstruction of investigations, including audits. It also gives permissive exclusion to the OIG for those making false statements, omissions, or misrepresentations in an enrollment or similar application to federal healthcare programs and allows for exclusion of those who fail to supply requested payment information for items or services. These three aspects of the final rule codify the Affordable Care Act’s expansion of the exclusion authority already granted to the OIG.

The final rule also allows the OIG to grant waivers for certain excluded entities if the administrator of that program requests them, allows for early reinstatement in certain cases, and adds a 10-year statute of limitations for exclusion actions.