AHCA Submits Comments on Guidance Relating to Medicaid/Medicare Exclusion List

Recently, the Department of Health and Human Services' ("HHS") Office of Inspector General ("OIG") solicited comments from Medicare and Medicaid providers as to the potential need for updated guidance as to the OIG's excluded provider program. Under the program, the OIG has the authority to exclude from participation in the Medicare and Medicaid program providers who have committed certain health care-related offenses, or have had their licenses revoked or suspended (as well as for many other reasons). If a provider is excluded, and an entity subsequently bills Medicare or Medicaid for services attributable to that excluded provider, the OIG can recover the sums paid, in addition to hefty penalties. The current OIG "authority" on the matter comes in an outdated 1999 Special Advisory Bulletin, where the OIG outlined the ins and outs of the exclusion program. It looks like something new might be coming out though, and if the American Health Care Association's ("AHCA") comments are taken to heart, the new OIG guidance will include information about the OIG's intent to further utilize its current exclusion authority with respect to individuals based on their relationships with corporations that have been found guilty of health care-related offenses. Additionally, AHCA smartly suggested that the OIG make clear what happens when a provider self-discloses the fact that they may have billed for services provided by an excluded provider? Hopefully, the OIG will take all of the AHCA's suggestions into consideration. New OIG guidance on these matters is expected sometime this Spring.

If you have questions about the Medicaid/Medicare exclusion program, or about AHCA's recent comments to the OIG, please contact Susan Ziel at 317-238-6244, or Leigh Ann Lauth O'Neill, at 317-238-6346.