Mandatory Exclusions

i-prescriptiondrugMandatory exclusions [42 U.S.C. § 1320a-7(a)]

The mandatory exclusions require OIG to exclude from Federal health care program participation any individual or entity convicted of:

  • a “program-related” [Medicare/Medicaid] crime (minimum 5 year exclusion)
  • a crime related to patient abuse or neglect (minimum 5 year exclusion)
  • certain felonies related to health care fraud (minimum 5 year exclusion)
  • a felony conviction related to controlled substances (minimum 5 year exclusion)
  • two mandatory exclusion offenses (minimum 10 year exclusion)
  • three mandatory conviction offenses (permanent exclusion).

Mandatory exclusions are virtually automatic; if the health care provider has been convicted of one of the enumerated offenses, he/she will be excluded for at least the minimum period of time (5-years, 10-years or permanently) called for under the particular exclusion. This minimum period can be extended, but not lowered, if certain aggravating factors are present. 42 CFR § 1001.102.

If you have been convicted of one of the mandatory exclusions, Mark Greenberg can help you minimize the length of the mandatory exclusion.