For hospitals, physician practices, post-acute providers, health plans, and suppliers that participate in Medicare and Medicaid, the power to remove an organization from federal programs carries direct financial and operational consequences.
Who holds that power, and how it is used, shapes enforcement risk across the industry.
In a recent article by Modern Healthcare, the publication examined a federal notice that extends permissive exclusion authority to CMS, which the HHS Office of Inspector General (OIG) has historically held alone. George B. Breen, Member of the Firm of Epstein Becker Green and counsel to health care providers, insurers, and suppliers on False Claims Act defense, government investigations, and exclusion risk, discussed what the change leaves unsettled.
The notice does not say who within CMS will make exclusion decisions or what information that office will rely on. It also does not say whether CMS will follow the oversight practices OIG has used for years. George pointed to corporate integrity agreements, which OIG often requires in False Claims Act settlements, and noted it is unclear whether CMS will take the same approach. For organizations facing an investigation, that uncertainty affects settlement strategy and the risk of losing program participation.
George expects the transition to be gradual.
“There is going to be, in my view, a significant learning curve here,” Breen said.
Get in Touch
To discuss how CMS exclusion authority may affect your organization’s Medicare and Medicaid participation, enforcement exposure, and compliance program, contact George Breen at gbreen@ebglaw.com.
