Providers could be removed from Medicare and Medicaid for obstructing audits under newly proposed rule

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Providers could be removed from Medicare and Medicaid for obstructing audits under newly proposed ru
Providers could be removed from Medicare and Medicaid for obstructing audits under newly proposed ru

Long-term care providers who obstruct audits soon could have their Medicare and Medicaid certifications revoked, according to a newly proposed rule from a top federal watchdog.

Currently, individuals and organizations can be booted from Medicare or Medicaid if they are convicted of obstructing a criminal investigation. The Affordable Care Act empowered the government to also kick out those who are found guilty of obstructing audits. The Department of Health and Human Services Office of Inspector General has created a rule to implement this ACA provision, which was published Friday in the Federal Register. 

In determining the length of the Medicare or Medicaid exclusion, current regulations set an “aggravating factor” of $1,500 or $5,000, depending on the type of wrongdoing. This means that lengthier exclusions apply for acts that resulted in or were intended to result in financial losses to the government above these thresholds. The new rule proposes updating the aggravating factor to $15,000. The last update came in 2002.

“We believe this updated amount is an appropriate threshold that is consistent with rationale behind the original amount and provides a realistic marker for determining whether someone is untrustworthy,” the proposed rule states.

The government also should be able to exclude providers and suppliers who make false statements in “any application, agreement, bid or contract” related to federal health programs, the OIG proposed.

One of the most vigilant nursing home watchdogs, the OIG might be scaling back its oversight this year, an official recently told a Congressional panel.

Comments on the proposed rule on exclusions are being accepted through July 8.

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