decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Exclusion / Permissive Exclusion / False or improper claims
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Article Overview
This article provides a general overview of how the OIG may use permissive exclusion authority when false claims, false statements, or related civil money penalty law violations are involved. It is aimed at health care compliance, coding, and billing professionals who need to understand the scope of exclusion-related guidance, the factors considered in determining exclusion length, and the type of example scenario used to illustrate the issue.
Why This Topic Matters
Exclusion can affect a provider’s ability to participate in federal health care programs and is a major compliance risk. Understanding the general framework helps organizations recognize when billing and claims practices may trigger enforcement attention.
What You Will Learn
- How OIG permissive exclusion authority is described in connection with false or improper claims.
- What broad factors may be considered when determining the length of an exclusion.
- How an illustrative example is used to show the type of conduct discussed in the article.
- Which enforcement concepts and regulatory references are involved in the discussion.
Who Should Read This
- Health care compliance professionals
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Auditors
Codes Discussed
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