Optional_2023 Board Resources

Felony conviction relating to a controlled substance. 75

(iv)

(b) Multiple Exclusions . Conviction of two mandatory exclusion offenses listed above in Section 5.2(a) results in mandatory exclusion for a minimum period of 10 years. 76 Conviction of three or more mandatory exclusion offenses listed above in Section 5.2(a) results in mandatory permanent exclusion. 77 5.3 Permissive Exclusions . As opposed to mandatory exclusions, permissive exclusions allow HHS-OIG to exercise discretion. The following are actions that would trigger permissive exclusion: (a) Misdemeanor conviction relating to health care fraud (baseline exclusion period of 3 years); 78 (b) Conviction relating to fraud in non-health care programs (baseline exclusion period of 3 years); 79 (c) Conviction relating to obstruction of an investigation (baseline exclusion period of 3 years); 80 (d) Misdemeanor conviction relating to controlled substances (baseline exclusion period of 3 years); 81 (e) License revocation or suspension (exclusion period no less than the period imposed by the state licensing authority); 82 (f) Exclusion or suspension under a federal or state health care program (exclusion period no less than the period imposed by the federal or state health care program); 83

(g)

Claims for excessive charges, unnecessary services or services which fail to meet professionally recognized standards of health care, or failure of an HMO to furnish medically necessary services (exclusion period no less than 1 year); 84 Fraud, kickbacks, and other prohibited activities (no minimum exclusion period); 85 Entities controlled by a sanctioned individual (exclusion period no less than the period of the individual’s exclusion); 86 Entities controlled by a family or household member of an excluded individual and where there has been a transfer of ownership or control (exclusion period no less than the period of the individual’s exclusion); 87

(h)

(i)

(j)

75 42 U.S.C. § 1320a-7(a)(4). 76 42 U.S.C. § 1320a-7(c)(3)(G)(i). 77 42 U.S.C. § 1320a-7(c)(3)(G)(ii). 78 42 U.S.C. §1320a-7(b)(1)(A). 79 42 U.S.C. § 1320a-7(b)(1)(B).

80 42 U.S.C. § 1320a-7(b)(2). 81 42 U.S.C. § 1320a-7(b)(3). 82 42 U.S.C. § 1320a-7(b)(4); see 42 C.F.R. §1001.501(c) for a description of the early reinstatement process.

83 42 U.S.C. § 1320a-7(b)(5). 84 42 U.S.C. § 1320a-7(b)(6). 85 42 U.S.C. § 1320a-7(b)(7). 86 42 U.S.C. § 1320a-7(b)(8). 87 42 U.S.C. § 1320a-7(b)(8)(A).