decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Exclusion / Permissive Exclusion / Misdemeanor conviction relating to controlled substances
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Article Overview
This premium article provides a high-level overview of an OIG exclusion provision connected to criminal convictions involving controlled substances. It is intended for compliance, billing, auditing, and health care legal professionals who need to understand the scope of the exclusion category, the general length of exclusion, and the categories of factors that may influence how the exclusion period is determined. The article also includes an illustrative example to show how the provision may be applied in practice.
Why This Topic Matters
Health care organizations and professionals need to recognize exclusion categories that can affect program participation, compliance risk, and employment or contracting decisions. Understanding the broad framework of this exclusion topic helps readers identify when further review of regulatory and administrative guidance is warranted.
What You Will Learn
- The general basis for an OIG exclusion related to controlled substances.
- The broad categories of factors that may affect exclusion length.
- How this exclusion topic is framed in a compliance and program-participation context.
- How an illustrative example relates to the exclusion subject matter.
Who Should Read This
- Medical coders
- Billing professionals
- Compliance officers
- Health care administrators
- Health care attorneys
- Revenue cycle staff
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