CMS rule allows agency to exclude providers from programs

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The Centers for Medicare & Medicaid Services published a final rule this month that allows the agency to exclude providers from federal health programs.

Also under the rule, CMS has the authority to act on behalf of providers recommended for exclusion in such cases where exclusion could harm beneficiaries. The Department of Health and Human Services Office of Inspector General will recommend to CMS those providers that should be omitted from the program.

The rule finalizes a July 23, 2004, proposed rule, in which CMS said it planned to exercise its statutory exclusion authority. The OIG exercised similar exclusion authority under its civil monetary penalty authority. The rule becomes effective Aug. 20.