Federal program integrity efforts expanded again last week. During a July 20 press conference, Department of Health and Human Services Secretary Robert F. Kennedy Jr. announced plans to delegate to the Centers for Medicare & Medicaid Services authority to exclude individuals and organizations from participation in federal health care programs. That authority has historically been exercised by the HHS Office of Inspector General. LeadingAge is monitoring how CMS may use the authority and how it may intersect with other program integrity proposals.
What it means
Exclusion is different from Medicare enrollment revocation. Revocation removes a provider’s Medicare enrollment and billing privileges. Exclusion is broader: Medicare, Medicaid, and other federal health care programs generally cannot pay for items or services furnished, ordered, or prescribed by an excluded individual or entity. Depending on the basis for exclusion, the period may last several years and, in some cases, may be permanent.
Why it matters
This announcement comes while CMS is also proposing expanded Medicare enrollment denial and revocation authorities through the CY 2027 Home Health Proposed Rule. Taken together, these developments signal continued expansion of CMS enforcement tools across Medicare provider types, including home health and hospice. Detailed guidance has not yet been released explaining when or how CMS will exercise the exclusion authority.
What to do