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Prohibition on Medicare/Medicaid payments includes ancillary medical services provided by excluded individuals or entities.

Requirements

“The prohibition on Federal health care program payment for items or services furnished by an excluded individual includes items and services beyond direct patient care.

  • For instance, the prohibition applies to services performed by excluded individuals who work for or under an arrangement with a hospital, nursing home, home health agency, or managed care entity when such services are related to, for example, preparation of surgical trays or review of treatment plans, regardless of whether such services are separately billable or are included in bundled payment.
  • Another example is services performed by excluded pharmacists or other excluded individuals who input prescription information for pharmacy billing or who are involved in any way in filling prescriptions for drugs that are billed to a Federal health care program.
  • Also, excluded individuals are prohibited from providing transportation services that are paid for by a Federal health care program, such as those provided by ambulance drivers or ambulance company dispatchers.” 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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