Program exclusions and civil money penalties: the administrative process

The authority vested in the Secretary of Health and Human Services and the Office of Inspector General to combat fraud and abuse in the Medicare and state health care programs has continuously expanded during the past decade, and the government's experience in fighting fraud and abuse over the years has resulted in, and been augmented by, refined statutory and regulatory enforcement authority, culminating in the 1987 enactment of the Medicare and Medicaid Patient and Program Protection Act. This article addresses some of the expanded bases for exclusion and imposition of civil money penalties that were authorized by the 1987 legislation and set out in recently proposed regulations.