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What Happens When a Health Care Provider Has Been Excluded from Medicare or Another Federal Health Care Program?

Rodney K. Adams

This article discusses the mandatory and discretionary authority vested in the Secretary of the US Department of Health and Human Services (DHHS) regarding whether or not to exclude health care providers from participation in one or all of the federal health care programs including Medicare and Medicaid. This article also provides guidance to providers that if they open up a dialogue with DHHS and are able to marshall support from their state, the possibility exists that exclusion will not be imposed.

Key Words: Balanced Budget Act of 1997, civil monetary penalties • health care fraud and abuse • mandatory and permissive exclusion authority of the secretary, professional shortage area • sole community provider

Home Health Care Management & Practice, Vol. 12, No. 6, 1-5 (2000)
DOI: 10.1177/108482230001200604


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