For hospitals, physician groups, suppliers, and other organizations that bill Medicare and Medicaid, exclusion from federal health care programs cuts off payment from those programs.
The standards behind an exclusion decision and the appeal rights that follow it determine how much certainty an organization has when a compliance problem arises.
In a recent article by Healthcare Brew, the publication examined an October 14 notice that gives CMS the power to exclude providers and suppliers from federal health care programs. Across every federal health care program, the HHS Office of Inspector General (OIG) had held that authority alone. George B. Breen, Member of the Firm of Epstein Becker Green and counsel to health care providers and suppliers on False Claims Act defense, government investigations, and exclusion risk, discussed what remains unresolved.
The open questions include whether CMS and OIG will hold organizations to the same standards or offer the same appeal rights, George said. He described where CMS stands today.
“CMS, for all practical purposes, is a blank slate in the exclusion arena,” Breen said.
George added that it is also unknown what conduct CMS would treat as grounds for exclusion rather than a lesser penalty. Until that is settled, organizations have little to measure their exposure against. He recommended that participants in federal health care programs ask both agencies to clarify the process.
Get in Touch
To discuss how CMS’s new exclusion authority may affect your organization’s participation in federal health care programs and its compliance planning, contact George Breen at gbreen@ebglaw.com.
