Under the exclusion statute, whose billing is prohibited for the services of an excluded provider?

• A. The excluded provider
• B. The employer of the excluded provider
• C. The patient
• D. The state Medicaid agency

Answer: (B)

Exclusions follow the individual provider and stop federal health care programs from paying for the services that person delivers. That means the organization that employs or contracts with the excluded provider is not allowed to bill Medicare/Medicaid for those specific services. The money cannot flow through the employer for the excluded clinician’s work, so the employer is the entity barred from submitting those claims to the federal programs. This helps prevent funds from supporting care provided by someone who isn’t eligible to participate in federally funded health programs. The patient could be billed privately for the care, but not to Medicare/Medicaid, and the state Medicaid agency wouldn’t pay for those services when billed through the employer for the excluded provider.