decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Investigation Procedures / Administrative, Civil and Criminal Sanctions / Exclusion of Providers From Medicare and Medicaid / Exclusion of Providers from Medicare and Medicaid
Subscribe or sign in to view the full article.
Article Overview
This premium article covers Office of Inspector General (OIG) exclusion authority across major federal health care and assistance programs, with emphasis on the difference between mandatory and permissive exclusion. It is relevant to compliance staff, auditors, coders, and health care administrators who need a high-level understanding of provider sanctions, program participation impacts, and the types of factors considered in exclusion decisions.
Why This Topic Matters
Exclusion from federal programs can affect provider participation, reimbursement, and compliance risk. Understanding the broad structure of OIG sanction authority helps organizations identify when exclusion issues may arise and how they fit into administrative, civil, and criminal enforcement topics.
What You Will Learn
- The scope of OIG authority to exclude providers from federal health care and assistance programs.
- The distinction between mandatory and permissive exclusion categories.
- The broad kinds of circumstances that may influence exclusion decisions under OIG guidance.
- The relationship between exclusion topics and broader administrative, civil, and criminal sanction procedures.
Who Should Read This
- Compliance officers
- Health care administrators
- Medical billing and coding professionals
- Audit and revenue integrity teams
- Legal and regulatory staff
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com