The federal government has the authority to impose a broad-based payment ban for any item or service furnished by an excluded individual or entity.
Entities covered include:
- All methods of federal health care program reimbursement, whether payment results from itemized claims, cost reports, fee schedules, or a prospective payment system;
- Payment for administrative and management services not directly related to patient care, but that are a necessary component of providing items and services to federal health care program recipients when those payments are reported on a cost report or are otherwise payable by a federal health care program;
- Any items and services furnished at the medical direction or prescription of an excluded physician; and
- Payment to cover an excluded individual’s salary, expenses, or fringe benefits, regardless of whether they provide direct patient care, when those payments are reported on a cost report or are otherwise payable by a federal health care program.