• OIG Proposed Rules Would Expand Civil Monetary Penalty Authority and Exclusion Authority
  • May 30, 2014 | Authors: Leslie J. Levinson; Michaela ("Kayla") Tabela
  • Law Firms: Edwards Wildman Palmer LLP - New York Office ; Edwards Wildman Palmer LLP - Boston Office
  • On May 12, 2014, the HHS Office of Inspector General (OIG) published a proposed rule implementing the new civil monetary penalty (CMP) authorities provided under the Affordable Care Act. Specifically, the proposed rule would add the following new conduct to the list of actions subject to CMPs and exclusion:

    • failure to grant OIG timely access to records, upon reasonable request;
    • ordering or prescribing while excluded when the excluded person knows or should know that the item or service may be paid for by a Federal health care program;
    • making false statements, omissions, or misrepresentations in an enrollment or similar bid or application to participate in a Federal health care program;
    • failure to report and return an overpayment that is known to the person; and
    • making or using a false record or statement that is material to a false or fraudulent claim.

    Comments on this proposed rule are due July 11, 2014.

    The May 12th proposed rule was published just three days after the OIG’s May 9, 2014 proposed rule that would expand the OIG’s exclusion authority to persons or entities who:

    • have been convicted of an offense in connection with obstruction of an audit;
    • fail to supply payment information (the Affordable Care Act expanded this provision to apply to individuals who ‘‘order, refer for furnishing, or certify the need for’’ items or services for which payment may be made under Medicare or any State health care program); and
    • make, or cause to be made, any false statement, omission, or misrepresentation of a material fact in applications to participate as a provider of services or supplier under a Federal health care program.

    The rule also proposes a modification to the reinstatement rules for individuals excluded as a result of losing their licenses to allow them to rejoin the programs earlier when appropriate. Comments on this proposed rule are due July 9, 2014.