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The Department of Health and Human Services Office of Inspector General Releases Final Rule Effective February 13, 2017

February 16, 2017

Amendments Alter Regulations Relating to Exclusion Authority of HHS OIG

Section 1001.301 expands exclusion authority to a conviction of obstruction in the event of an audit. In an effort to hold individuals and entities accountable to provide access and information during an exclusion audit conducted by the Department of Health and Human Services Office of Inspector General, the new rule has provisions to come down hard on those who don’t devote resources and allow access to comply with audits.

The idea is to bring an audit on par with an investigation regarding expectations for compliance. Where there is no specific definition of the terms; official, investigation, audit, inspection, verification, examination; in the spirit of the statutory nature of the HHS OIG’s authority to apply the exclusions statute, obstruction by an individual or entity of interest indicates untrustworthiness.

Some commenters wanted to differentiate between what kind of action was deemed formal vs. informal in order to respond with appropriate time and resources while others were in support of extending the authority to the OIG to apply exclusion for obstruction whether it be an audit or an investigation.

This provides the most direct route to excluding individuals and entities from participation with a federal health care program that operate in a non-transparent manner.

Verisys CEO, John P. Benson says, “We provide cloud-based tools that ensure compliance that meets and exceeds OIG standards while providing a platform for ease in audits and investigations. All the required credentialing and compliance data is available at the touch of a button remotely via a secure portal. An inquiry by a state board, the OIG, or any regulating body should be simple and instantaneous providing the most current, primary-source data. The fact that most health care systems still run purely on paper is an invitation for forgery while simultaneously creating an obstacle to audits and investigations,” he said and continued, “With the impending conversion of CMS’s enrollment system to a cloud-based paradigm, individuals and entities who draw from the federal entitlement system should be required to evolve accordingly.”

The Final Rule can be found here:  https://www.gpo.gov/fdsys/pkg/FR-2017-01-12/pdf/2016-31390.pdf

Learn more about Verisys’ turn-key credentialing, compliance solution: https://vcom.verisys.com/product/checkmedic/

Susen Sawatzki Written by Susen Sawatzki
Healthcare Industry Expert
Muse. Writer. Publisher. Producer. Creator of Inspiring Narratives.
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