On May 8, 2013, the OIG issued a “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs”
This “Special Advisory” reiterated and clarified the obligations of providers to assess the status of individuals and entities that they employ or engage to provide services to federal healthcare programs. The implication of utilizing excluded providers can be severe.
The Special Advisory 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. It describes how exclusions can be violated and the administrative sanctions OIG can pursue against providers that employ, or receive referrals from, excluded individuals.
Providers should be proactive and develop a plan to address excluded providers. Frier Levitt has already represented providers who were subjected to recoupment of payments due to an excluded provider. In one circumstance, a pharmacy hired a pharmacist who possessed a valid pharmacist’s license, but failed to disclose that she was excluded from the Medicare program. The pharmacy now faces recoupment of all of the fees received for every prescription filled by the excluded pharmacist. Contact Frier Levitt to speak to an attorney today.
