Health Law Blog

CMS Announces New Exclusion Related Sanction: the Preclusion List

Aside from the United States Department of Health and Human Services Office of the Inspector General’s (OIG) Exclusion List for health care providers and entities, the Centers for Medicare and Medicaid Services (CMS) has recently established a new rule that created a Preclusion List for healthcare providers and entities as well. The new Preclusion List went into effect on April 1, 2019.

An individual or entity can find their name on the Preclusion List in two ways:

A healthcare provider or entity that finds their name on the Preclusion List will be precluded from receiving payments for Medicare Advantage items and services or Medicare Part D drugs. Part D providers will be mandated to reject prescriptions from any individual or entity that is on this list, and Medicare Advantage plans will be mandated to deny such payments. In contrast to the OIG’s Exclusion List, the Preclusion List is not accessible to the public, and therefore cannot be checked periodically by providers. Any provider or entity that is put on the Preclusion List will receive individual notice of the determination.

For more information concerning the CMS Preclusion List, please contact David R. Ross Esq. at (518) 462-5601 or via e-mail at Samantha L. Femia, Law Clerk, wrote this article.

Back to Top