Member Article

On April 18, the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services issued revised guidance regarding exclusions imposed under section 1128(b)(7) of the Social Security Act.1 That provision allows the OIG to “permissively” exclude individuals or entities from participation in all federal healthcare programs for engaging in certain prohibited conduct, usually the offering or paying of illegal kickbacks or submission of false or fraudulent claims. The OIG often invokes section 1128(b)(7) exclusion authority in False Claims Act (“FCA”) matters in exchange for integrity obligations. During the past several years, the OIG has been increasingly less reticent about bringing exclusion cases under 1128(b)(7) outside the FCA context.

The revised guidance describes how the OIG assesses a provider’s future risk to federal healthcare programs by placing the provider on what the OIG calls a “Risk Spectrum.” Next, it summarizes the categories the OIG considers when placing providers on the spectrum and determining whether to seek exclusion. The revised guidance replaces a 1997 OIG policy statement on the same topic.

Read the full alert.