HHS Delegates Permissive Exclusion Authority To CMS

Key Takeaways

• On October 14, HHS delegated permissive exclusion authority under Section 1128(b) of the Social Security Act to CMS, effective immediately, giving CMS independent power to bar individuals and entities from Medicare, Medicaid, and other federal healthcare programs.
• OIG retains its full exclusion authority, creating two parallel decision-makers within HHS, and CMS may redelegate the authority without clear limits on who can make exclusion decisions.
• Key questions remain regarding governing standards, interaction with other program integrity tools, appeals, Corporate Integrity Agreements, and False Claims Act and self-disclosure settlements.

On October 14, the U.S. Department of Health and Human Services (HHS) published a Statement of Delegation of Authority in which Secretary Robert F. Kennedy, Jr. delegated to the Administrator of the Centers for Medicare & Medicaid Services (CMS) the Secretary’s permissive exclusion authorities under Section 1128(b) of the Social