What does “exclusion” mean in a health care fraud investigation?

For health care providers, the most serious collateral consequence of a conviction for health care fraud is likely to be “exclusion.” In this context, exclusion means that the health care provider can no longer participate as a provider in federal and state health care programs such as Medicare and Medicaid.

Exclusion refers to an administrative action undertaken by the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services. OIG has the authority to exclude individuals and entities from participation in government health care programs when those people or entities have engaged in prohibited conduct.

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