Did It Just Get Easier to Ban Physicians from Medicare and Medicaid?


Medicare and Medicaid billings are the lifeblood for a majority of physicians: without them, many practices would be forced to fold. Being excluded from participating in federal health-care programs is therefore an effective death sentence. The Health and Human Services Office of Inspector General recently expanded its exclusion authority, and physicians would be smart to pay close attention.

I spoke with Foley & Lardner’s Judith Waltz, who told me that the OIG final rule is likely to change physician behavior, as the risks of exclusion are simply too high. For example, physicians will likely try to improve their cooperation with auditors and investigators.

“I think these provisions reflect the government's current approach to just get rid of providers they find untrustworthy,” Waltz said.

Under the recent final rule, the OIG gained new exclusionary authorities, including the ability to ban physicians who obstruct government audits, fail to provide investigators with prompt access to medical records and fail to provide accurate information on Medicare provider enrollment applications.

The OIG also set out a 10-year limit for pursuing an exclusion, meaning physicians can’t be banned for behavior that’s more than 10 years old. The proposed rule didn’t include any limits, which would have placed a major administrative burden on providers, Elizabeth Carder-Thompson, an attorney with Reed Smith, told me.

Carder-Thompson said she expects the OIG will increase the use of its exclusionary authority for both providers and suppliers.

For more information, please read my story here.

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