While many health care professionals are taking extraordinary steps to combat such health care foes as reduced payment from the Balanced Budget Act of 1997, increased regulations and a tight labor market, many have ignored a danger just as potent— a business associate who has been excluded from participation in the Medicare and Medicaid programs.
The federal government uses exclusion as a powerful weapon to combat abuses of Medicare and Medicaid. Briefly stated, any individual or entity ("person") (e.g., physician partner, medical staff member, owner, managing employee) that abuses a federal or state health care program risks being excluded from further participation in those programs. There are two types of exclusion laws in the Social Security Act, Section 1128 (42 U.S.C. Section 1320):
