The Department of Health and Human Services Office of Inspector General (OIG) announced yesterday it would not move forward with a final rule to define excessive charges. The OIG stated that it could not identify a “single, fixed numerical benchmark” that would apply across the industry. In addition, the OIG expressed concern that the rule might increase healthcare costs. The OIG stated it would “continue to evaluate billing patterns of individuals and entities on a case-by-case basis.” Individuals or entities found to charge “substantially in excess” of “usual charges” can be excluded from the Medicare program, but the OIG's long-standing position is that "when calculating their ‘usual charges’ for purposes of Section 1128(b)(6)(A) [pertaining to exclusion for excessive charges] individuals and entities do not need to consider free or substantially reduced charges to (i) uninsured patients or (ii) underinsured patients who are self-pay patients for the items or services furnished.”
Download the notice of withdrawal from the Federal Register. Download the OIG addendum explaining the withdrawal and the OIG enforcement policy.
