Excluded By Medicare: Avoiding It and What to Do If It Happens To Your Staff

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

How to Avoid Being Excluded from Medicare and What to do if Staff Gets Excluded Anyway

Providers should be aware that their participation in Medicare can be jeopardized not only if they utilize staff who are themselves excluded or “debarred”, but also if the practice or facility is suspected of inappropriate billing. Recent amendments to the Medicare exclusion rules, authorized under the ACA, continue to expand the circumstances under which a provider can be kicked out of the program. For example, the new rules permit a provider to be suspended while “suspected” fraud is investigated, which could take months or years. Unsuspecting providers can find that they are cut out of Medicare simply upon notice.

In addition to being aware of events causing exclusion or suspension, providers should have a protocol to identify and deal with employees or contractors who are debarred or excluded. There are lists that should be routinely checked to assist in this process. However, best practices dictate that providers need a complete due diligence protocol which involves more than just checklists. Recent settlements with the OIG provide insights as to what the government expects. For example, the protocol also must specify how often diligence will be completed and the steps to take if a staff person is excluded.

If a provider becomes aware of facts that could trigger exclusion or suspension, it may be necessary to disclose the information. There are existing self-disclosure protocols that can be considered. Using these may result in lesser penalties, but there are definite downsides that providers should be aware of.

Join expert speaker Wayne J. Miller, Esq. in this 60-minute audio session to discuss what it means to be excluded or debarred, and the recent rules that describe new ways this can occur. He will review the best practices for the due diligence protocol to use when hiring and during engagement of staff. Additionally, Wayne will also address the timing and method of responding to disclosure of an event that could lead to suspension or exclusion or the identification of debarred staff, as well as the considerations of self-disclosure.

Session Highlights:

  • When can a provider be excluded or debarred from Medicare?
  • Impact of suspension and ways to undo this status
  • Is termination the only option for a debarred employee?
  • Best practices for employee status review protocols
  • Appeal rights to contest a suspension or exclusion decision
  • Considerations in self-disclosing negative events
  • Potential penalties if tainted contractors are retained
  • Insights on Self Disclosures: up and downsides
  • Review protocol beyond just OIG lists

Session Agenda:

  • Medicare exclusion generalities
  • Main exclusion list sources
  • Staff due diligence recommendations
  • Lessons from the trenches
  • Addressing excluded staff
  • Reinstatement rules

Who should attend

Physicians, medical groups, medical group administrators or managers, hospitals, long term care facilities and health care consultants.


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About Our Speaker

Wayne J. Miller - Healthcare Compliance Expert

Wayne J. Miller, Esq., is a founding partner of the Compliance Law Group, Los Angeles, a law firm focused on health care industry legal compliance for clients nationwide. Wayne has practiced healthcare business and regulatory law throughout his 30-year career. His firm represents a wide range of healthcare industry clients throughout the nation. He is a frequent speaker for The Coding Institute national teleconferences on healthcare reimbursement, transactional and regulatory...   More Info
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