OIG to Provide Updated Guidance on Exclusion Authority

The Department of Health and Human Services Office of Inspector General plans to release updated guidance on its exclusion authority within the next few months. Providers can expect to receive updated guidance on three areas:

1. Best Practices: The new guidance will include best practices for organizations to follow, and will explain how the OIG resolves cases in which an entity hires or contracts with an excluded person.
2. Self-Disclosure Protocol: The guidance will provide a revised self-disclosure protocol, stemming from the OIG’s call for comments and recommendations in a June 18 Federal Register notice.
3. Anti-Fraud Efforts: The guidance will cover an effect of the Affordable Care Act (ACA) that authorizes the OIG to exclude or penalize anyone who lies on their Medicare application. Additionally, the updated guidance will likely cover provisions of the ACA granting authority to suspend payments when there is a credible allegation of fraud, and the 60-day repayment rule requiring providers to identify and return an improper payment within 60 days.

Although updated guidance is expected, providers should continue to abide by the OIG’s current best practice policies.