Payment to an Excluded Practitioner or Other Person –

9055.1 – Payment to an Excluded Practitioner or Other Person – Regulatory Requirements (Rev. 24, Issued: 02-12-16, Effective: 03-14-16, Implementation: 03-14-16) 1. Payment will not be made under the Medicare, Medicaid, or any other Federal health care programs as defined in §1128B(f) of the Act, including State health care programs as defined in §1128(h), to an excluded practitioner or other person for items or services furnished, ordered, or prescribed during the period of exclusion. 2. Payment will not be made under Medicare, Medicaid, or any other Federal health care programs to any provider for items or services ordered by an excluded practitioner or other person when the order was a necessary precondition for payment under Medicare when the person furnishing the item or service knew or had reason to know of the exclusion. 3. Assignment of a beneficiary’s claim for items or services furnished or ordered by an excluded practitioner or other person on or after the effective date of exclusion will not be valid.