decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Exclusion / Permissive Exclusion / Failure to supply payment information
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Article Overview
This article covers a Medicare and Medicaid program integrity topic involving OIG permissive exclusion for failure to supply payment information or to permit access to records. It is relevant to compliance staff, billing professionals, auditors, and healthcare administrators who need a high-level understanding of exclusion authority, the factors considered in determining exclusion length, and an illustrative enforcement scenario.
Why This Topic Matters
Understanding this exclusion category helps healthcare organizations recognize a compliance risk tied to payment verification and record access. The article is useful for readers who monitor fraud-and-abuse exposure, exclusion risk, and government enforcement activity.
What You Will Learn
- The general basis for an OIG permissive exclusion involving payment-information issues
- The broad factors considered when determining how long an exclusion may last
- How an enforcement example illustrates the type of conduct that can trigger exclusion review
- The role of Medicare and Medicaid record and payment verification in program integrity
Who Should Read This
- Healthcare compliance professionals
- Medical billers and coders
- Practice managers
- Healthcare attorneys
- Auditors and fraud-waste-abuse personnel
Codes Discussed
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