Under the exclusion statute, which statement is true?

• A. The provider's employer may not bill for the provider's services.
• B. The excluded provider may bill for treating patients.
• C. The provider's employer may bill private payers for all services.
• D. The provider may bill only for administrative tasks.

Answer: (A)

When a provider is excluded from participation in federal health care programs, funds from those programs cannot be paid for anything they furnish. That means the employer may not submit claims to Medicare or Medicaid (or other federal payers) for the excluded provider’s services. The prohibition is designed to prevent payment for services delivered by someone who has been sanctioned from federal programs, so the statement that the provider’s employer may not bill for the provider’s services aligns with that rule.

The other options run into problems because an excluded provider cannot participate in billing for services that would be paid by federal programs, and the exclusion specifically targets federal program payments rather than private-pay scenarios. The idea that the provider would be limited to administrative tasks or could bill private payers for all services does not reflect the federal program billing restriction at the heart of the exclusion.