Denial of Payment to Employer of Excluded Physician

4.10.2.5.1 - Denial of Payment to Employer of Excluded Physician (Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21) If an excluded physician is employed in a hospital setting and submits claims for which payment is prohibited, the MAC surveillance process usually detects and investigates the situation. However, in some instances an excluded physician may have a salary arrangement with a hospital or clinic, or work in group practice, and may not directly submit claims for payment. If this situation is detected, MACs: • Contact the hospital/clinic/group practice and inform them that they are reducing the amount of their payment by the amount of federal money involved in paying the excluded physician • Develop and refer to the UPIC as a CMP case. Upon referral from the MAC, the UPIC shall finalize the case and refer it to the OIG.