STATUTORY AUTHORITY
1128(b)(6) — Claims for excessive charges or unnecessary services
Submission of claims for items or services substantially in excess of the usual charge or cost, or for services that were not medically necessary or failed to meet professionally recognised standards.
What this means for a placement decision
Federal health care programmes will not pay for any item or service furnished by, or at the medical direction of, an excluded party. Civil monetary penalties can accrue per claim submitted. Confirm the identity of this record against the person or entity in front of you before acting on it — the OIG file carries name, date of birth, and where available an NPI for exactly that purpose.
Confirming identity
This record carries no NPI. Identity must be confirmed against the other corroborating fields before it is treated as a match — a name alone is not an identification.
Verify against the OIG online searchable database →