New OIG Guidance Publishes on Permissive Exclusions from Federal Health Care Program Participation
By Miles Indest, J.D./M.B.A candidate at Tulane University: Law Clerk, The Health Law Firm
On April 20, 2016, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released updated non-binding criteria that disclosed when a company or individual can be barred from participating in Medicare, Medicaid, and other federal health care programs.
The OIG has permissive authority to exclude a person or company from participation in federal health care programs for engaging in certain prohibited conduct, such as false claims or kickbacks. The OIG has consistently asserted that there is a presumption in favor of exclusion. The new guidance updates the OIG’s position by stating that its presumption in favor of exclusion is rebuttable in certain situations. Importantly, the OIG guidance outlines those situations and the risk factors that trigger an exercise of its permissive authority.
Four Factors May […]
By Miles Indest, J.D./M.B.A candidate at Tulane University: Law Clerk, The Health Law Firm