Basis for Exclusion Under §1128(b)(6) of the Social Security

4.10.2.1 - Basis for Exclusion Under §1128(b)(6) of the Social Security Act (Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21) Exclusions under §1128(b)(6) of the Act are effected upon a determination that a provider has done one of the following: • Submitted or caused to be submitted claims or requests for payment under Medicare or a state health care program containing charges (or costs) for items or services furnished substantially in excess of its usual charges (or costs). • Furnished or caused to be furnished items or services to patients (whether or not eligible for benefits under Medicare or under a state health care program) substantially in excess of the needs of such patients or of a quality that does not meet professionally recognized standards of health care. For purposes of the exclusion procedures, “furnished” refers to items or services provided or supplied, directly or indirectly, by any individual or entity. This includes items or services manufactured, distributed or otherwise provided by individuals or entities that do not directly submit claims to Medicare, Medicaid or other Federal health care programs, but that supply items or services to providers, practitioners or suppliers who submit claims to these programs for such items or services.