Statutes & Regulations

• No payments may be made to a provider for items or services furnished by an excluded provider
• No payment may be made by a State for any items or services ordered or prescribed by an excluded physician
• This includes persons furnishing administrative and management services
• This prohibition extends to IT services, strategic planning, billing and accounting, staff training, and human resources

Provider Requirements

• Compliance with exclusion regulations is mandatory under Medicare and Medicaid
• All 50 states require monthly screening of employees
• Contractors and vendors must also be screened
• A number of states require that you certify that none of your employees, contractors and vendors have been excluded from federal or state programs

Consequences of Non-Compliance

• Violations must be self-disclosed
• Monies received in violation may be considered overpayments
• Civil monetary penalties may be assessed
• The improper retention of federal or state funds may implicate the False Claims Act