The OIG has authority to exclude any individual or entity from participation in Federal health care programs if the individual or entity provides unnecessary items or services (i.e., items or services in excess of the needs of a patient) or substandard items or services (i.e., items or services of a quality which fails to meet professionally recognized standards of health care). Significantly, neither knowledge nor intent is required for exclusion under this provision. The exclusion can be based upon unnecessary or substandard items or services provided to any patient, even if that patient is not a Medicare or Medicaid beneficiary.

We are mindful that the vast majority of hospitals are fully committed to providing quality care to their patients. To achieve their quality-related goals, hospitals should continually measure their performance against comprehensive standards. For example, hospitals should meet all of the Medicare hospital conditions of participation (COP), including without limitation, the COP pertaining to a quality assessment and performance program at 42 CFR 482.21 and the hospital COP pertaining to the medical staff at 42 CFR 482.22. Hospitals that have elected to be reviewed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) should maintain their JCAHO accreditation.66 In addition, hospitals should develop their own quality of care protocols and implement mechanisms for evaluating compliance with those protocols.

Finally, in reviewing the quality of care provided, hospitals must not limit their review to the quality of their nursing and other ancillary services. Instead, hospitals must also take an active part in monitoring the quality of medical services provided at the hospital by appropriately overseeing the credentialing and peer review of their medical staffs.