Yellow Card or Red Card? OIG Updates Criteria for Exclusion from Federal Health Care Programs

Picture yourself as a physician, health care administrator, or nurse. The government initiates a False Claims Act (FCA) investigation and you (or your company), as a provider, commence an immediate internal investigation. The findings are brought to the government, you promptly correct any errors, and a settlement is in sight. This begs the question: What’s next?

Depending on the settlement, the government may not deprive a person’s liberty through prison, but it might take away a health care professional’s freedom to work. Medicare and Medicaid account for nearly 40 percent of the nation’s health expenditure ‑ and this number is only going to rise. For the medical professional who has devoted his or her entire career to health care, what is the professional to do if he or she can’t treat Medicare or Medicaid patients?

This week, the Office of the Inspector General (OIG) published new criteria for implementing FHP exclusion authority. Those that pose the highest risk to federal health programs warrant exclusion. As this risk decreases, so do the remedies: heightened scrutiny, integrity obligations, no further action, and release (self-disclosure). This criteria will be useful to providers in determining potential risks when dealing with an FCA investigation.

Source: Yellow Card or Red Card? OIG Updates Criteria for Exclusion from Federal Health Care Programs NATIONAL LAW REVIEW

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