decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Balanced Budget Act of 1997 / Companies run by family relations of sanctioned individuals
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Article Overview
This premium article covers a Medicare fraud and exclusion issue addressed by the Balanced Budget Act of 1997. It explains the general policy background for companies connected to excluded individuals, the role of family or household relationships, and why the provision matters for compliance and exclusion screening. The content is aimed at coders, compliance staff, auditors, and healthcare organizations that need to understand the legal context and related terminology.
Why This Topic Matters
The topic matters because ownership, control, and family or household relationships can affect exclusion and compliance risk for healthcare-related businesses. Understanding the policy helps organizations recognize when a business relationship may trigger government action under exclusion rules.
What You Will Learn
- The policy background for exclusion-related enforcement under the Balanced Budget Act of 1997.
- How family and household relationships are relevant to company exclusion issues.
- Why transfer of control or ownership can be important in compliance review.
- The general legal and regulatory context for anti-fraud exclusion provisions.
Who Should Read This
- Medical coders
- Compliance officers
- Healthcare auditors
- Revenue cycle professionals
- Healthcare attorneys
- Provider enrollment staff
Codes Discussed
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