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HomeFocus → New exclusion rules to take effect next month

New exclusion rules to take effect next month Print E-mail
Written by Vitale Health Law   
Monday, 30 January 2017 00:00

Earlier this month, the Health and Human Services Office of the Inspector General (HHS-OIG) finalized its long-awaited rules on civil monetary penalties that could make it easier for providers to be excluded from participating in the Medicare and Medicaid programs.

The final rule, which was published in the Federal Register on January 12, was first proposed in 2014 and updates HHS' exclusion authority to include those who are found guilty of obstructing audits. Previously, only those convicted of obstructing criminal investigations faced program exclusion.

The final rule, which takes effect Feb. 13, builds on changes implemented by the Affordable Care Act to expand OIG's authority even more.

The new rule did, however, implement a 10-year statute of limitations, which the OIG noted "addresses the commenters' concerns about administrative burden and courts' historical favoring of an enumerated limitations period."

On average, OIG noted that it excludes approximately 3,500 healthcare providers per year.

The length of exclusion is determined by a number of factors including: previous convictions for healthcare fraud, the amount of the financial loss, and the reason for the exclusion.

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