A person can end up on the OIG List of Excluded Individuals for a range of reasons and the main effect of being excluded is that individuals cannot receive payment through Medicare, Medicaid or any other federal health care program for items or services rendered. If a health care provider employs an excluded individual, payment can be withheld from the provider as well, and they may face additional fines.
The OIG will also not allow federal health care funds to pay out on items or services furnished at the prescription or medical direction of a physician on the state exclusion list if the individual knows or should know of their exclusion.
Payment for administrative or management services provided by an excluded individual is prohibited as well, unless their services aren’t related to patient care. However, payment will still be prohibited if the administrator is a necessary component of providing services and items to patients in federal health care programs.
This includes claims processing, billing and accounting, staff training, strategic planning, health information technology services and support and human resources unless these tasks are completely separate from federal health care programs. Ambulance drivers, nurses and other medical staff on the exclusion list will not be paid through federal health care either.
Individuals have to apply for reinstatement to be removed from the OIG’ bad boy list, and this will not reinstate the individual through other excluding bodies.