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Special Advisory Bulletin and Other Guidance

Special Advisory Bulletin

Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs
Special Advisory Bulletin | May 9, 2013

This updated Special Advisory Bulletin describes the scope and effect of the legal prohibition on payment by Federal health care programs for items or services furnished (1) by an excluded person or (2) at the medical direction or on the prescription of an excluded person. For purposes of Office of Inspector General (OIG) exclusion, payment by a Federal health care program includes amounts based on a cost report, fee schedule, prospective payment system, capitated rate, or other payment methodology. It describes how exclusions can be violated and the administrative sanctions OIG can pursue against those who have violated an exclusion. The updated Bulletin provides guidance to the health care industry on the scope and frequency of screening employees and contractors to determine whether they are excluded persons.

The Effect of Exclusion From Participation in Federal Health Care Programs
Special Advisory Bulletin | September 1999

Guidance

Guidance for Implementing Permissive Exclusion Authority Under Section
1128(b)(15) of the Social Security Act

This notice sets forth nonbinding factors the Office of Inspector General (OIG) will consider in deciding whether to impose permissive exclusion in accordance with section 1128(b)(15)(A)(ii) of the Social Security Act, which authorizes OIG to exclude an officer or managing employee of an entity that has been excluded or has been convicted of certain offenses.

Criteria for Implementing Permissive Exclusion Authority Under Section
1128(b)(7) of the Social Security Act

This notice sets forth the non-binding guidelines, to be used by the OIG in assessing whether to impose a permissive exclusions in accordance with section 1128 (b) (7) of the Social Security Act.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201