Health Law Blog - Healthcare Legal Issues

Excluded Parties – OIG Bulletin On Reimbursement

OIG Bulletin On Reimbursement For Services of Excluded Parties

excluded party reimbursementThe Office of Inspector General has issued an updated Special Advisory Bulletin that describes the scope and effect of the legal prohibition on payment for services that are provided by excluded parties. The Advisory Bulletin was issued on May 9, 2013.

The updated Bulletin provides guidance to the health care industry on the scope and frequency of screening employees and contractors to determine whether they are excluded persons.

In the Bulletin, the OIG clarifies that services that are furnished by an excluded person or under the medical direction or prescription of an excluded person do not qualify for reimbursement under Federal health care programs.

Payment by a Federal health care program can include amounts based on a cost report, fee schedule, prospective payment system, capitated rate, or other payment methodology.

The OIG Bulletin describes how the exclusion prohibition can be violated and the administrative sanctions OIG can seek.

See: Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs; Special Advisory Bulletin dated May 9, 2013

Random Posts


Tags: , , , ,

Comments are closed.

John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

The Health Care Law Blog is made available by Ruder Ware for educational purposes and to provide a general understanding of some of the legal issues relating to the health care industry. This site does not provide specific legal advice and you should not use the information contained on this site to address your specific situation without consulting with legal counsel that is well versed in health care law and regulation. By using the Health Care Law Blog site you understand that there is no attorney client relationship between you and Ruder Ware or any individual attorney. Postings on this site do not represent the views of our clients. This site links to other information resources on the Internet; these sites are not endorsed or supported by Ruder Ware, and Ruder Ware does not vouch for the accuracy or reliability of any information provided therein. For further information regarding the articles on this blog, contact Ruder Ware through our primary website.