This updated Special Advisory Bulletin describes the scope and effect of the legal prohibition on payment by Federal health care programs for items or services furnished (1) by an excluded person or (2) at the medical direction or on the prescription of an excluded person. For purposes of Office of Inspector General (OIG) exclusion, payment by a Federal health care program includes amounts based on a cost report, fee schedule, prospective payment system, capitated rate, or other payment methodology. It describes how exclusions can be violated and the administrative sanctions OIG can pursue against those who have violated an exclusion. The updated Bulletin provides guidance to the health care industry on the scope and frequency of screening employees and contractors to determine whether they are excluded persons.
This notice sets forth updated criteria the OIG considers in evaluating exclusions under section 1128(b)(7) of the Social Security Act. This revised policy statement supersedes and replaces the 1997 Federal Register Notice.
This notice sets forth nonbinding factors the Office of Inspector General (OIG) will consider in deciding whether to impose permissive exclusion in accordance with section 1128(b)(15)(A)(ii) of the Social Security Act, which authorizes OIG to exclude an officer or managing employee of an entity that has been excluded or has been convicted of certain offenses.