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Editor's Welcome

This week we discuss recent proposed rules from the Office of Inspector General (OIG) concerning its ability to exclude providers from the Medicare program for excessive charges. The information contained in this CodeMap Briefing is derived from the Federal Register for Monday, September 15, 2003. As always please feel free to e-mail questions regarding this newsletter or ideas for future CodeMap Compliance Briefings.

Sincerely,

Gregory Root, Esq.

Background Information

The Social Security Act contains provisions that allow the OIG to exclude providers from participation in all federally funded health care programs if the provider submits charges to these programs that are substantially in excess of the provider's customary or usual charges. The recent proposed regulations serve to better define the terms, "substantially in excess" and "usual charges." These powers and associated regulations are designed to protect tax dollars by ensuring that Medicare and other federal health care programs do not pay higher prices than othe....

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