Healthcare Consulting Services for Medical and Behavioral Health Practices

CMS may deny or revoke Medicare enrollment when any of a practice’s “administrative or management services personnel furnishing services payable by a federal health care program” is excluded, and those include “W-2 employees and contracted individuals and organizations” (42 CFR 424.530(a)(2), 424.535(a)(2)). OIG may penalize a practice that employs or contracts with someone it “knows, or should know” is excluded (42 CFR 1003.200(b)(4)): up to $25,595 for each item or service that person provides (2025 amount, in force through 2026), plus up to 3 times the total costs, salary and benefits included, when the work isn’t billed separately (42 CFR 1003.210). Screen healthcare consulting companies and the people they assign as you screen staff (OIG exclusion checks).

Running operations adds two more rules:

• Managing employee. Medicare’s definition covers anyone with operational or managerial control of day-to-day operations, “either under contract or through some other arrangement, whether or not the individual is a W-2 employee” (42 CFR 424.502). The CMS-855B lists a “Contracted Managing Employee” in section 6; Medicaid collects each one’s name, address, date of birth and Social Security number (42 CFR 455.104(b)(4)).
• Florida Level 2 screening, by role. For AHCA-licensed providers it covers the administrator “or a similarly titled person who is responsible for the day-to-day operation” and the financial officer (s. 408.809(1)(b)–(c); AHCA background screening).