A Final Rule recently issued by CMS will require Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) providers and suppliers to disclose current and previous affiliations (direct or indirect) with a provider or supplier that: (1) has uncollected debt; (2) has been or is excluded by the OIG (Office of Inspector General) from Medicare, Medicaid or CHIP, or (3) has had its billing privileges with either of these three programs denied or revoked. Such provider affiliations may lead to enrollment being denied if it poses a risk to fraud, waste or abuse.
The Government recently clarified six areas related the effect of exclusion from participation in Federal Healthcare Programs.
Switching professions during a period of exclusion does not change the exclusion and payment prohibitions.
You can accept a referral from an excluded provider as long as the excluded provider does not provide any services to the referred patient.
Being excluded along with the payment prohibitions extends beyond just direct patient care.
If you are excluded you cannot provide either administrative or management services to non excluded provider.
Excluded providers cannot even provide volunteer services, and
Excluded providers can work for non excluded providers as long as the services they provide are furnished to non-federal healthcare program patients.
Providers need to screen every professional, employee and contractor they do business with to insure they are not on the Exclusion list. It is always best to check the list of Excluded Individuals/Entities (LEIE) for anybody you work with.
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