Glossary
Exclusion
An exclusion is an action by the HHS Office of Inspector General (OIG) or a state Medicaid program that bars a person or organization from federal or state health care programs. No program payment is made for items or services they furnish, order or prescribe.
What to know
- OIG imposes exclusions under sections 1128 and 1156 of the Social Security Act. Some are required by law (mandatory), others are at OIG’s discretion (permissive).
- The payment ban reaches Medicare, Medicaid and every other federal health care program, other than the Federal Employees Health Benefits Program.
- An exclusion also affects the organizations that work with the person: an employer or contractor that bills federal programs for their services can face civil monetary penalties.
- An OIG exclusion lasts for a set period, or until a condition such as regaining a license is met, and ends only when OIG grants reinstatement.
Official sources
Read more
Related terms
Check names against every list at once
Exclia checks your employees, contractors and vendors against federal and state lists, keeps a dated record of every check, and flags potential matches for your review.