On January 12, 2017, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) issued final rules implementing permissive exclusion authorities authorized by the Affordable Care Act expanding exclusion authority under Section 1128 of the Social Security Act. The changes were first proposed on May 9, 2014 at 79 Federal Registered 26810.
Although there were numerous technical and definitional changes, the major policy changes are as follows:
- The rules implement the ACA exclusion and permission exclusion authority regarding all individuals and entities convicted for the interference with oral instruction of both investigations and audits related to the use of funds received from a federal health care program.
- The regulations implement expanded permissive exclusion authority for any individual or entity furnishing, ordering, referring or certifying the need for items and services for which payment may be made under a federal health care program that fails to provide certain payment information upon authorized request.
- The rules implement the ACA’s expanded permissive exclusion authority for knowingly making or causing to be made any false statement, omission, or misrepresentation of material fact in any application, agreement, bid, or contract to participate or enroll as a provider of services or supplier under a federal health care program.
Read the full text of the announcement and final regulations here.