decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Investigation Procedures / Billing After a Provider was Suspended, Excluded or Terminated
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Article Overview
This short Find-A-Code article addresses OIG investigation procedures related to claims submitted after a provider has been suspended, excluded, or terminated from Medicare or Medicaid. It is useful for compliance staff, billing professionals, and auditors who need a high-level understanding of sanctions-related claim risk and the oversight focus described by HHS and OIG.
Why This Topic Matters
Sanctions status can affect whether claims may be payable and can trigger civil money penalty exposure. Understanding the compliance context helps billing and auditing teams recognize risk areas tied to sanctioned providers and claims submitted through other entities.
What You Will Learn
- The general compliance issue involved when claims are submitted after a provider sanction.
- How OIG frames post-sanction billing risk in federal health care programs.
- Why sanctioned-provider billing patterns are relevant to oversight and investigation.
- The role of HHS and OIG in monitoring these situations.
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Audit professionals
- Health care administrators
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