Five Federal Laws Continued: The Exclusion Statute
Under the Exclusion Statute, a physician or other individual who is convicted of one or more of four specific criminal offenses can, at the the discretion of the OIG, Office of Inspector General, be banned from participating in Medicare and Medicaid programs.
These offenses are:
1. Medicare or Medicaid fraud (both misdemeanor and felony convictions)
2. Patient abuse and neglect
3. Felony convictions for other health care-related fraud, theft, or other financial misconduct
4. Illegal distribution, prescription or dispensing of controlled substances
Practices should not employ or contract with excluded physicians or individuals if it is possible that services furnished by those individuals or entities could be billed to Medicare, Medicaid, or other federally funded programs such as Tricare and Veterans Health Administration. To ensure this, physicians are responsible for accessing the OIG's online database of excluded individuals and entities before they employ an individual or enter into a business contract. http://oig.hhs.gov/exclusions/
Excluded physicians may not bill directly for treating Medicare and Medicaid patients, nor may their services be billed indirectly through an employer or a group practice. In addition, if you furnish services to a patient on a private-pay basis, no order or prescription that you give to that patient will be reimbursable by any Federal health care program.
For further information on the exclusion statute, please visit http://oig.hhs.gov/exclusions/background.asp
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