OIG Updates Exclusion Advisory
On May 8, 2013 the Office of Inspector General (OIG) issued a Special Advisory Bulletin that updates the scope and effect of the legal prohibition on payment by federal health care programs for items or services both furnished by an excluded person and at the medical direction of an excluded person. The Advisory Bulletin describes how statutory amendments made since the most recent Advisory in 1999 have expanded OIG’s authority to exclude individuals and entities from federal health care programs. It also explains how exclusions may be violated as well as the administrative sanctions that the OIG can pursue. The Special Advisory Bulletin also includes recommendations about the scope and frequency of screenings. Of particular interest to home health and hospice providers is guidance about the need to screen volunteers for exclusion.
The guidance explains that payment prohibition applies to all methods of federal health care program payment, regardless of if the payment comes from itemized claims, cost reports, fee schedules, capitated payments, a prospective payment system or other bundled payment, or another payment system. Payment prohibitions apply even if the payment is made to a state agency or to a person that is not excluded and includes items and services beyond direct patient care. The bulletin also explains how excluded persons are prohibited from furnishing administrative and management services that are payable by the federal health care programs even though these services are not separately billable. Examples given of such services include health information technology services, strategic planning, billing and accounting, staff training, and human resources.