On May 9, 2014, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) proposed a new rule that when it goes into effect, will increase the exclusion authority of the OIG. The purpose of the proposal is to update the OIG’s exclusion authority to align with the Affordable Care Act of 2010. For those interested in making comments, the Proposal reference file code is OIG-403-P2.
There are three main expansions of the OIG exclusion authority. The OIG will be able to exclude based on the following:
1) “Conviction of an offense in connection with Obstruction of an audit;”
2) “Failure to supply payment information (ACA expanded this provision to apply to individuals who ‘‘order, refer for furnishing, or certify the need for’’ items or services for which payment may be made under Medicare or any State health care program)”
3) “Making, or causing to be made, any false statement, omission, or misrepresentation of material fact in applications to participate as a provider of services or supplier under a Federal health care program.”
Additionally, the OIG will also be able to “issue testimonial subpoenas in investigations of exclusion cases under section 1128 of the Act” and reinstate “individuals excluded as a result of losing their licenses to allow them to rejoin the programs earlier when appropriate.”
At Typhoon Data, we closely monitor the OIG exclusion list and update our products regularly to ensure the highest data quality. As the OIG expands the number of excluded individuals and entities, we’ll be keeping that data updated in our product suites. The OIG data set is part of our Basic, Basic+, and Standard product sets.