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.
Health Care Financing Administration, US Dept of Health and Human Services.National health expenditures by type of service and source of funds: calendar years 1960-97 (last modified July 27, 1999). http://www.hcfa.gov/stats/nhe-oact/nhe.htm . Accessed April 23, 2000.
2.
Jackpot: Gaming the Home Health Care System: Hearings before the Senate Special Comm. on Aging, 105th Cong. 67 ( 1997).
3.
Health care fraud is high priority for Justice, attorney general claims. Medicare Rep. June 14, 1996:D-31.
4.
42 U.S.C. § 1320a-7a (1998).
5.
42 U.S.C. § 1320a-7b (1998).
6.
42 U.S.C. § 1320a-7 (1998).
7.
42 U.S.C. § 1320a-7b(f) as enacted by the Health Insurance Portability and Accountability Act of 1996 § 204(a)(7), Pub. L. No. 104-191, 110 Stat. 1936, 2000 (1996).
8.
Medicare and Medicaid Patient and Program Protection Act of 1987 § 2, Pub. L. No. 100-93, 101 Stat. 680 (1987).
9.
42 U.S.C. § 1320a-7(a)(c) (1998).
10.
42 U.S.C. § 1320a-7(c)(3)(B) (1998).
11.
42 U.S.C. § 1320a-7(d)(3)(B)(i) (1998).
12.
Balanced Budget Act of 1997, Pub. L. No. 105-33, 111 Stat. 251 (1997).
13.
BBA § 4301(3) (1997).
14.
42 U.S.C. § 1320a-7(c)(3)(G) (1998).
15.
42 U.S.C. § 1320a-7(b)(1) (1998).
16.
42 U.S.C. § 1320a-7(b)(2) (1998).
17.
42 U.S.C. § 1320a-7(b)(3) (1998).
18.
42 U.S.C.§ 1320a-7(c)(3)(D) (1998).
19.
42 U.S.C. § 1320a-7(b)(4)(A) (1998).
20.
42 U.S.C. § 1320a-7(c)(3)(E) (1998).
21.
42 U.S.C. § 1320a-7(b)(8) (1998).
22.
42 U.S.C. § 1320a-7(b)(8)(A)(iii) (1998).
23.
42 U.S.C. § 1320a-7(b)(6) (1998).
24.
42 U.S.C. § 1320a-7(b)(7) (1998).
25.
42 U.S.C. § 1320a-7(b)(9) (1998).
26.
42 U.S.C. § 1320a-7(b)(10) (1998).
27.
42 U.S.C. § 1320a-7(b)(11) (1998).
28.
42 U.S.C. § 1320a-7(b)(12) (1998).
29.
42 U.S.C. § 1320a-7(b)(13) (1998).
30.
42 U.S.C. § 1320a-7(b)(14) (1998).
31.
42 U.S.C. § 1320a-7(b)(15) (1998).
32.
BBA § 4302 (1997).
33.
42 U.S.C. § 1320a-7(c)(1) (1998).
34.
42 U.S.C. § 1320a-7(d)(2) (1998).
35.
42 U.S.C. § 1320a-7(e) (1998).
36.
42 C.F.R. § 1001.1901(c) (1999).
37.
42 U.S.C. § 1320a-7(c)(2)(B) (1998).
38.
Health Care Financing Administration, US Dept of Health and Human Services. Medicare Intermediaries Manual. 1995: 3982.7. http://www.hcfa.gov/pubforms/program.html. Accessed April 23, 2000.
39.
Starr P.The Social Transformation of American Medicine. New York : Basic Books; 1982:368.
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Williams SJ, Torrens PRIntroduction to Health Services. Albany, NY: Delmar Publishers;1988.
