The authority to effectuate exclusions from participation in federal health care programs under the Social Security Act has long been held solely by the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG). HHS regulations under title 42 of the Code of Federal Regulations outline the role of the OIG in program integrity and enforcing program exclusions. During a July 20, 2026, press conference, Secretary Robert F. Kennedy Jr. announced that he was delegating this exclusion authority to the Centers for Medicare and Medicaid Services (CMS), which they could use to apply a permanent exclusion from Medicare program participation.

The regulations address the parameters for exclusions, with minimum terms of five years for mandatory exclusions and no cap on the duration of an exclusion. With both OIG and CMS now having the authority to exclude providers, this consolidation of power is potentially concerning, and we will continue to monitor the intersection with other policy proposals.