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CodeMap® 04/21/2022: Exclusion Provisions Concerning Excessive Charges

CodeMap® Compliance Briefing: April 21, 2022


Editor's Welcome:

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. In recent weeks, several subscribers have asked for clarification concerning these exclusion rules and how the OIG might apply them to clinical laboratories. As this CodeMap® Compliance Briefing will demonstrate, guidance from the federal government is sparse and includes no easy to explain standards or tests for what are excessive charges. We will do our best to present what information currently applies a....

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