Which statement about Exclusion from federal health care programs is true?

Which statement about Exclusion from federal health care programs is true?

• A. Exclusion means provider may still bill.
• B. Exclusion means provider cannot be excluded.
• C. The government may exclude a provider from federal health care programs, meaning provider cannot bill for treating patients.
• D. Exclusion only applies to doctors.

Answer: (C)

Exclusion from federal health care programs is a formal sanction that bars a person or entity from participating in programs like Medicare and Medicaid. When someone is excluded, they cannot receive payment from these federal programs for any services, and they cannot bill patients for those services under those programs. The restriction applies to individuals and entities, not just physicians. Exclusion can result from fraud, abuse, license actions, or criminal convictions, among other program violations, and reinstatement can be possible only after meeting certain conditions. So the statement that the government may exclude a provider from federal health care programs, meaning the provider cannot bill for treating patients, is true. The other options don’t fit because exclusion does not permit billing for federal program services, it can apply to more than just doctors, and it can indeed be imposed.

Exclusion from federal health care programs is a formal sanction that bars a person or entity from participating in programs like Medicare and Medicaid. When someone is excluded, they cannot receive payment from these federal programs for any services, and they cannot bill patients for those services under those programs. The restriction applies to individuals and entities, not just physicians. Exclusion can result from fraud, abuse, license actions, or criminal convictions, among other program violations, and reinstatement can be possible only after meeting certain conditions. So the statement that the government may exclude a provider from federal health care programs, meaning the provider cannot bill for treating patients, is true. The other options don’t fit because exclusion does not permit billing for federal program services, it can apply to more than just doctors, and it can indeed be imposed.