What’s an exclusion?

The Health and Human Services Office of the Inspector General (HHS-OIG) has the authority to exclude individuals and entities from federally and state-funded healthcare programs. The goal of an exclusion is to ensure that federal and state funds don’t go towards a person or organization that’s been identified as a perpetrator of fraud, waste, or abuse.

If the OIG excludes an individual, such as a physician, that individual is not eligible to receive payment from an organization that receives Medicare and/or Medicaid funding. The same is true for entities, which can include vendors that provide services to healthcare organizations, whether the vendor’s services are related to patient care or not.