CMS Expands Exclusion Authority for Medicaid, Boosting Fraud Enforcement
Medicaid-participating healthcare providers, suppliers, and managed care organizations now face heightened exclusion risk after HHS granted CMS new authority to bar entities from Medicaid funding, expanding the government's healthcare fraud enforcement toolkit.
HHS has formally transferred exclusion authority—previously held exclusively by the HHS Office of Inspector General (OIG)—to the Centers for Medicare & Medicaid Services (CMS), a shift that will significantly strengthen government healthcare fraud enforcement efforts. The exact division of exclusion responsibilities between OIG and CMS remains unannounced, as it will depend on the terms of the formal delegation of authority between the two agencies. Medicaid-participating healthcare providers, suppliers, and managed care organizations should review and update their compliance programs to mitigate expanded exclusion risk, track forthcoming guidance on the agency authority split, and prepare to respond to potential CMS exclusion inquiries that fall outside OIG’s traditional enforcement scope.