Knowledge – Experience –Integrity

HHS Exclusion and CMP Defense

The attorneys at Nicholson & Eastin, LLP represent health care providers in all types of Medicare Civil Monetary Penalty and Exclusion actions.

The HHS Office of Inspector General as well as the Centers for Medicare and Medicaid Services have the authority to impose monetary sanctions against Medicare and Medicaid providers for a wide range of regulatory violations, such as:

  • the submission of false claims,
  • violations of the anti-kickback statute,
  • Stark violations;
  • EMTALA violations;
  • failure to timely refund overpayments; and
  • violations of various conditions of participation and payment, including documentation, billing and quality of care deficiencies.

In addition to monetary penalties, HHS-OIG has provider exclusion authority, and CMS has the authority to revoke a provider's provider number. Both revocation and exclusion can be devastating to a provider's practice and career, and can lead to licensure action by the Department of Health, as well as the loss of hospital privileges and insurance contracts. Some violations require mandatory exclusion or revocation, others are permissive in nature. With respect to the permissive exclusion/revocation authorities, both HHS-OIG and CMS have discretion in whether to impose the sanction, and for how long.

Any provider that receives a notice that HHS-OIG or CMS is considering whether to impose civil monetary penalties, revocation or exclusion should seek the advice of counsel as soon as possible.