Posts Tagged List of Excluded Individuals and Entities

New Guidance and Penalties for Healthcare Transactions with ‘Excludeds’

Tuesday, July 23rd, 2013 | Permalink

In May, 2013 the Office of Inspector General (OIG) of Health and Human Services (HHS) issued new guidance on the penalties associated with the payment of claims made to ‘Excluded individuals or entities’ for any Federal Health program (primarily Medicare and Medicaid). The authority to impose civil fines and deny payment for claims resides in various Federal statutes including most recently the Affordable Care Act of 2010. An Excluded person or entity is defined as one who has engaged in fraud or abuse related to Federal Health programs and the penalties may include a $10,000 fine for each claimed item or service and may also be subject to an assessment of up to 3X the amount claimed.

Guidance on what constitutes liability, falls not only on the Excluded person or entity BUT ALSO TO A NON-EXCLUDED PERSON, PROVIDED the NON-EXCLUDED PERSON KNEW or ‘SHOULD HAVE KNOWN’ they were dealing with an ‘Excluded’ person.

As examples: (more…)

 

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