Under what circumstance can the Office of Inspector General take enforcement action against a provider?

The Office of Inspector General (OIG) can take enforcement action against a provider for hiring an excluded person because it directly violates regulations that prohibit healthcare providers from employing individuals excluded from federal healthcare programs. This exclusion typically results from prior misconduct such as fraud, abuse, or otherwise not meeting the necessary ethical and professional standards. When a provider hires someone who is on the exclusion list, it puts the integrity of the healthcare program at risk and undermines patient trust. The OIG's enforcement actions are designed to maintain the quality and safety of care by ensuring that only qualified and eligible individuals are involved in providing services funded by federal programs.

The remaining options pertain to actions that, while potentially problematic, do not trigger automatic enforcement by the OIG. For instance, providing care without a license might lead to legal repercussions but isn’t specifically within the realm of the OIG's enforcement authority concerning federal program exclusions. Similarly, failing to submit insurance claims or not communicating with patients, while serious issues in their own right, do not fall directly under the purview of the OIG's focus on preventing fraud and safeguarding program integrity.