In previous columns, we have discussed the government’s expansive war on health care fraud. Federal prosecutors are bringing many more criminal and civil cases, and although recoveries by the government (and private whistleblowers) have significantly increased, health care fraud continues to be a major problem. Federal officials have conceded that even billion dollar recoveries and heavy fines and penalties have not had a sufficient deterrent effect. As a result, besides bringing criminal and civil cases, the government is deploying another potent weapon with increasing frequency: the exclusion penalty.1
The U.S. Department of Health and Human Services (HHS), which administers Medicare and other government health benefit programs, has the statutory authority to ban an individual or entity from billing any government health benefit program, and from providing items or services to patients covered by those programs. The statutory authority for exclusion is found at 42 USC §1320a-7 et seq. The law authorizes exclusion of entities and individuals from Medicare, Medicaid, and all other federal or federally funded health benefit programs.
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