OIG was established in the U.S. Department of Health and Human Services (Department) to identify and eliminate fraud, waste, and abuse in the Department's programs and to promote efficiency and economy in Departmental operations. OIG carries out this mission through a nationwide program of audits, inspections, and investigations. In addition, the Secretary has delegated authority to OIG to exclude from participation in Medicare, Medicaid, and other Federal health care programs Persons that have engaged in fraud or abuse and to impose civil money penalties (CMPs) for certain misconduct related to Federal health care programs.
The effect of OIG exclusion is that no Federal health care program payment may be made for any items or services furnished (1) by an excluded person or (2) at the medical direction or on the prescription of an excluded person.
The exclusion and the payment prohibition continue to apply to an individual even if he or she changes from one health care profession to another while excluded. This payment prohibition applies to all methods of Federal health care program payment, whether from itemized claims, cost reports, fee schedules, capitated payments, a prospective payment system or other bundled payment, or other payment system and Applies even if the payment is made to a State agency or a person that is not excluded.
Why should you attend: Balanced Budget Act authorized the imposition of CMPs against providers that employ or enter into contracts with excluded persons to provide items or services payable by Federal health care programs. This authority parallels the CMP for health maintenance organizations that employ or contract with excluded individuals.
If a health care provider arranges or contracts (by employment or otherwise) with a person that the provider knows or should know is excluded by OIG, the provider may be subject to CMP liability if the excluded person provides services payable, directly or indirectly, by a Federal health care program. OIG may impose CMPs of up to $10,000 for each item or service furnished by the excluded person for which Federal program payment is sought, as well as an assessment of up to three times the amount claimed, and program exclusion.
A provider could be subject to CMP liability if an excluded person participates in any way in the furnishing of items or services that are payable by a Federal health care program. Attend this webinar to learn what you can to do to avoid unnecessary penalties.
Areas Covered in the Session: