The U.S. Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) recently updated its Exclusions Frequently Asked Questions (“FAQs”) to address the expansion of the Centers for Medicare & Medicaid Services’ (“CMS”) authority to exclude individuals and entities from Federal health care programs.
On October 14, 2026, through Federal Register notice, HHS formally delegated to CMS the authority to impose permissive exclusions from Federal health care programs. Previously exercised exclusively by OIG, this authority allows CMS to exclude individuals and entities from Federal health care programs for certain misconduct, including specified fraud-related offenses, licensing violations, and other conduct affecting program integrity. CMS and OIG now possess overlapping authority to impose permissive exclusions. OIG’s updated FAQs provide the following information regarding the exclusion authority:
- Mandatory Exclusions Remain with OIG. OIG will continue to exercise exclusive authority over mandatory exclusions, including exclusions arising from certain criminal convictions involving Medicare or Medicaid fraud, patient abuse or neglect, felony health care-related fraud, theft, or other financial misconduct, and felony controlled-substance offenses.
- OIG Will Continue Resolving Permissive Exclusion Issues in False Claims Act Settlements. Parties negotiating False Claims Act settlements with the Department of Justice will not need to separately engage CMS regarding potential exclusion. OIG will continue to resolve permissive exclusion matters on behalf of HHS.
- Case Allocation Between CMS and OIG Remains Unclear. Although OIG confirmed that it will coordinate with CMS in exercising their respective exclusion authorities, the agencies have not yet finalized how they will allocate cases or otherwise administer their overlapping responsibilities.
- Public Reporting Procedures Are Being Developed. OIG indicated that it is working with CMS to make exclusion information publicly available. However, the agencies have not finalized procedures for reporting CMS-imposed exclusions through OIG’s List of Excluded Individuals and Entities.
While the updated FAQs provide some clarification regarding OIG’s continued role in False Claims Act settlements, many questions about how CMS will exercise this new enforcement authority remain unanswered. Health care providers and other organizations participating in Federal health care programs should continue monitoring developments concerning CMS’s exclusion authority, particularly the agency’s coordination and public reporting procedures.
