All health care professionals and healthcare
businesses have to go through an intricate federal and state laws as well as
regulations. Failing to abide by those rules results in intense negative
consequences. One such consequence is the OIG exclusion list, where the
individual will be excluded from participating in any kind of Medicare and
other health care programs. Therefore, it is mandatory for all employers to
conduct OIG
Exclusion Check to make sure their employee names are not on
the list.
There are various offences which can prevent
an individual from participating in any kind of federal and state health care
programs.
·
Mandatory
or compulsory exclusions occur because of health care related crimes, like
patient abuse, misdemeanour related to health care fraud related to a
controlled substance.
·
Permissive
exclusions that occur because of misconduct convictions in relation to health
care fraud, unlawful production, sharing, prescription and giving out
controlled substance and capitalise false claims to state
health care program amid others.
Now let's see how an individual
becomes excluded.
OIG exclusion is the ultimate administrative
OIG action that prevents an individual from participating in any kind of
federal health care program. When an individual is found to create risks to the
safety of a patient or any kind of fraud in the health program, exclusions are
obligatory. The federal health care programs are not liable to pay for any kind
of services done by an excluded entity. Once an individual is in the exclusion
list, they are well thought out excluded in all states. In simple words, when
an individual is excluded in one state it means he has lost the permission to
participate in any kind of federal healthcare programs in every state.
The whole OIG exclusion process is done based
on the social security act. The whole process of administration is the same for
permissive as well as mandatory exclusions. What OIG does is send a written
notice of intent to the person that includes the reason for exclusion as well
as its consequence. But the first notice doesn't convey that the individual
will be excluded. The final decision is made after considering the materials
offered by the individual.
Read More:- https://exclusionscreening.wordpress.com/2019/06/18/all-you-should-know-about-the-oig-exclusion-list/
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