Final Rule Released to the OIGs Exclusion Authorities

On January 11, 2017, the Office of Inspector General (OIG) of the Department of Health and Human Services released a final rule that incorporates statutory changes, early reinstatement provisions, and policy changes, and clarifies existing regulatory provisions to the OIG’s authorities to exclude persons and entities from participating in Federal health care programs. The Affordable Care Act of 2010 expanded the OIG’s authority to exclude various individuals and entities from participation in Federal health care programs under section 1128 of the Social Security Act (Act). The changes in the final rule to the OIG’s authority were also based on the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which amended the OIG’s authority to waive certain exclusions under section 1128 of the Act.

A copy of the final rule is available at:

Written by: Clay J. Countryman

Countryman, Clay headshot

OIG Issues Proposed Rule to Add New Safe Harbors and CMPs on Beneficiary Inducements and Gainsharing

The Office of Inspector General (OIG) issued a Proposed Rule on October 2, 2014 that would amend the safe harbors to the Anti-Kickback Statute and the civil monetary penalty (CMP) rules to add new safe harbors to codify statutory changes in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the Patient Protection and Affordable Care Act, that would protect certain payment practices and business arrangements from criminal prosecution or civil sanctions under the Anti-Kickback Statute.  The OIG also proposed to codify certain revisions to the definition of “remuneration,” added by the Balanced Budget Act (BBA) of 1997 and ACA and add a gainsharing CMP provision in the OIG’s regulations. Continue reading