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Medicare/Medicaid payments are prohibited to healthcare providers if an excluded individual or entity is serving in an executive or leadership role or providing other administrative and management services for the provider.

Requirements

“Excluded persons are prohibited from furnishing administrative and management services that are payable by the Federal health care programs. This prohibition applies even if the administrative and management services are not separately billable.

  • For example, an excluded individual may not serve in an executive or leadership role (e.g., chief executive officer, chief financial officer, general counsel, director of health information management, director of human resources, physician practice office manager, etc.) at a provider that furnishes items or services payable by Federal health care programs.
  • Also, an excluded individual may not provide other types of administrative and management services, such as health information technology services and support, strategic planning, billing and accounting, staff training, and human resources, unless wholly unrelated to Federal health care programs.”   OIG Special Advisory Bulletin on the Effect of Exclusion From Participation in Federal Health Care Programs (May 8, 2013) 7
Related posts
Guidelines for health care providers to screen employees, contractors and vendors monthly against LEIE exclusion list.
April 8, 2016
OIG imposes large fines, monetary penalties and possible program exclusion upon providers that employ or enter into contracts with excluded persons or entities to provide items or services payable by Federal health care programs.
April 8, 2016
Items and Services that Excluded Parties May Be Furnishing Which Will Subject Their Employer or Contractor to Possible Civil Monetary Penalty (CMP) Liability
April 8, 2016
Medicare/Medicaid payments are prohibited to providers who furnish any items and services at the medical direction or on the prescription of an excluded person.
April 8, 2016
Providers are responsible to ensure that the ordering or prescribing physician is not excluded from participation in Medicare/Medicaid.
April 8, 2016
CMS Licensure Requirements for Medicare and Medicaid Providers and Suppliers
April 8, 2016
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Application Researchers® has been in operation since 1994 and has been providing OIG LEIE research for more than fifteen years. We use a proprietary, internet-accessible software (Zip24AR®), which allows clients to securely request service, view progress in real-time and view/store reports.

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Recent News
  • 11-01-2018 Ohio Nursing Home Settles Case Involving Excluded Individual
    November 14, 2018
  • 10-30-2018 Kansas Financial Management Services Provider Settles Case Involving Excluded Individual
    November 14, 2018
  • 10-05-2018 Arkansas Assisted Living Facility Settles Case Involving Excluded Individual
    October 29, 2018
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