Industry News

HHS Proposes Revisions to the OIG’s Exclusion Authorities.

On May 9, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a proposed rule to revise the OIG’s exclusion authorities.  The proposed rule would: (1) Codify changes pursuant to the Medicare Modernization Act and the Patient Protection and Affordable Care Act (2) Create early reinstatement procedures; (3) Clarify existing regulatory provisions; and (4) Expand the “pay the first claim rule” to Medicare Parts C and D.

The updated regulations would subject an individual to exclusion from participation in federal health care programs for the following:

  • Conviction of an offense in connection with obstruction of an audit;
  • Failure to supply payment information; and
  • Making, or causing to be made, any false statement, omission, or misrepresentation of a material fact in Federal health care program provider applications.

Further, the proposed rule specifies that there is no time limitation to exclusions imposed under section 1128 of the Social Security Act.

The OIG is accepting comments on the proposed rule until July 8, 2014.

The OIG proposed rule is available at:

Medicare and State Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Exclusion Authorities; Proposed Rule, 79 Fed. Reg. 90 (May 9, 2014).