CMS delegated exclusion authorities for Medicare, Medicaid

The Department of Health and Human Services has delegated the Centers for Medicare & Medicaid Services certain statutory authorities to exclude individuals and entities from federal healthcare programs, including Medicare and Medicaid, effective immediately, HHS announced in a Federal Register notice. The delegation grants CMS similar authority to exclude and permanently ban providers as the HHS Office of Inspector General has following investigations. “As the agency directly responsible for administering Medicare and Medicaid, CMS is uniquely positioned to investigate, identify, and develop the evidentiary basis underpinning permissive exclusion determinations,” HHS said. “Formalizing this delegation aligns investigative and enforcement responsibilities within a single operating division, reducing redundancy and improving program integrity outcomes.”

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