Providers who obstruct audits face exclusion from Medicare, Medicaid under final rule

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Healthcare providers who interfere with audits risk being barred from the Medicare and Medicaid programs, under a final rule issued Wednesday by the Department of Health and Human Services.

The rule, which was first proposed in 2014, updates HHS' exclusion authority to include individuals and organizations found guilty of obstructing audits. That authority was previously limited to those convicted of obstructing criminal investigations; the update was called for within the Affordable Care Act.

Public response to the rule included some concern about putting audits, which one commenter called “informal,” on the same level as investigations. Doing so would require providers to spend additional time and funds on ensuring compliance, the commenter noted, cutting into time spent on patient care.

“Contrary to the commenter's characterizations, audits by governmental entities or contractors are formal in nature, similar to investigations,” HHS said in the final rule. “Compliance with audit processes and requests is integral to fraud prevention and detection by payors and by law enforcement. It is appropriate for providers to devote resources to compliance with such audits.”

The HHS Office of Inspector General will be restricted to a 10-year period to pursue exclusions related to providers obstructing audits. The limited time frame will help ease providers' concerns about the administrative burden linked to the new exclusions, HHS said.

The final rule also includes an early-reinstatement option for individuals excluded from participation in federal healthcare programs, granted that their suspension was not related to incidents of patient abuse or neglect.

The rule is slated to be published in the Federal Register on Thursday; it will become effective on Feb. 13.