Category Archives: Exclusion

Protecting Your Organization From Exclusion Sanctions – Compliance Today Article

The federal government has a wide array of sanctions it can levy against individuals and organizations that run afoul of the laws and regulations governing Medicare, Medicaid, and other federal healthcare programs.
One of its most effective tools is the ability to exclude persons convicted of certain criminal or civil violations from further participation in federal healthcare programs. Protecting your organization from individuals and entities that are excluded is an integral part of the operations of any organization that does business with federal health care programs.

Ari J. Markenson and Kelly Skeat discuss these issues in a recent article in the September issue of the Health Care Compliance Association’s Compliance Today magazine.

A copy of the article can be found here —> Protecting Your Organization From Exclusion Sanctions

OIG Issues Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs

On May 8, 2013, the Office of Inspector General (OIG) issued an updated Special Advisory Bulletin (Updated Bulletin) on the effects of exclusion from participation in Federal health care programs. The Updated Bulletin replaces the original bulletin on the topic issued in September 1999. The Updated Bulletin describes the scope and effect of the legal prohibition on submitting a claim or receiving a payment from a Federal health care program for items or services furnished: a) by an excluded person; or b) at the medical direction or prescription of an excluded person. An excluded person is a person whom the OIG has excluded from participation in Medicare, Medicaid, and other Federal health care programs after finding that the person has engaged in fraud, abuse, or other misconduct relating to Federal health care programs. Continue reading

HRSA Announces Merger of NPDB and HIPDB

The Health Resources and Services Administration (HRSA) has announced that the Healthcare Integrity and Protection Data Bank (HIPDB) and the National Practitioner Data Bank (NPDB) will merge on May 6, 2013.  On that date, the HIPDB will close down, and all future reporting must be done through the NPDB.

While the databases are merging, there has been no change in the reporting requirements.  Any user who was previously required to report information to the HIPDB must now do so through the NPDB. All information currently in the HIPDB will now be available through the NPDB. Continue reading

OIG Report: The Low Hanging Fruit – Excluded Providers in Medicaid Managed Care Plans

On September 27, 2012, the US Department of Health and Human Services Office of the Inspector General’s (“OIG”) Office of Evaluation and Inspections issued a report (OEI-07-09-00632) entitled “Excluded Individuals Employed by Providers Enrolled in Medicaid Managed Care Entities”.

Identifying excluded individuals that are connected to the Medicare and Medicaid programs has traditionally been low-hanging fruit for the government. It is an easy issue to prove and the recoveries can be significant. This study is just one more example of the OIG’s focus on an easy area for enforcement.

You can find a discussion of what excluded individuals are and how to avoid the issue in our Benesch Issue Brief entitled “Individuals Excluded from Federal Health Care Programs or Federal Contracting: Protecting Your OrganizationContinue reading