Strengthening Medicare Anti-Fraud Measures Act of 2011: Extending the Permissive Exclusionary Authority of OIG, in AHLA’s Fraud and Abuse E-Newsletter

Anjali Downs, an Associate in the Health Care and Life Sciences practice in the Firm's Washington, DC, office, wrote an article titled "Strengthening Medicare Anti-Fraud Measures Act of 2011: Extending the Permissive Exclusionary Authority of OIG," in AHLA's Fraud and Abuse E-Newsletter.

Following is an excerpt:

On February 11, 2011, Congressman Wally Herger introduced H.R. 675, "Strengthening Medicare Anti-Fraud Measures Act of 2011" (Anti-Fraud Act). This bill would amend title XI of the Social Security Act to expand the permissive exclusion authority of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). Under Section 1128(b)(15) OIG has permissive authority to exclude individuals controlling a sanctioned entity. The Anti-Fraud Act would extend OIG's reach to individuals and entities affiliated with sanctioned entities.

Under the proposed Anti-Fraud Act, Section 1128(b)(15) of the Social Security Act would be amended to add that: (1) any individual who has an ownership or control interest in a sanctioned entity or an affiliated entity of such sanctioned entity and who knows or should know of such conduct; (2) any individual who is an officer or managing employee of a sanctioned entity or affiliated entity of such sanctioned entity; or (3) any affiliated entity of a sanctioned entity may be excluded from participating in any federal healthcare program.