Reinstatement After OIG Exclusion is Not Automatic

Wednesday, September 10, 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

An issue we frequently handle is Office of Inspector General (OIG) exclusion from the Medicare program following a conviction for a healthcare-related offense. An OIG exclusion blocks a healthcare provider from working for any individual or entity that contracts with federally funded programs in any capacity. For example, if a healthcare provider receives a five-year OIG exclusion, he or she cannot work as an employee, independent contractor or volunteer for any Medicare provider for that time. However, after the five-year exclusion period, reinstatement for the healthcare provider is not automatic. The healthcare provider remains on the List of Excluded Individuals and Entities (LEIE) until an application for removal is filed, reviewed and approved by the OIG.


Tips for Getting Reinstated.

If a healthcare provider is excluded, he, she or it can apply for reinstatement within 90 days of the expiration of the exclusion. It can take up to six months or more for the OIG to rule on the case. Reinstatement packages sent before the 90-day mark will not be considered.

When preparing an application for reinstatement from the OIG exclusion list, be sure to:

-  Complete all areas of the applications, including the applicant's initials acknowledging every question asked, regardless of relevance;
-  Disclose all prior places of employment and residency during the exclusion time;
-  Verify information for any of the contacts submitted;
-  Provide documentation that is favorable to reinstatement, including character reference letters, employer evaluations, educational completion, psychological or behavioral evaluations, and professional references; and
-  Attain representation by a competent, effective healthcare attorney with experience in these matters.

For an example of a letter from the OIG granting both reinstatement to the Medicare program and removal from the LEIE, click here.


Exclusion Can Have Devastating Effects.

Many don’t understand the significant repercussions that an exclusion action by the OIG can have on the career and employment of a licensed health professional. Whether you are a physician, nurse, dentist, psychologist or other health professional, if you allow yourself to be excluded from the Medicare program, devastating economic results may follow. These include, for example:

-  Termination for cause from all state Medicaid Programs.
-  Loss of state professional licenses in other states and jurisdictions.
-  Loss of hospital, ambulatory surgical center (ASC), and nursing home clinical privileges.
-  Removal from the provider panels of health insurers.
-  Loss of ability to contract or work for any individual or entity that contracts with the Medicare Program in any capacity (officer agent, shareholder, director, employee or independent contractor, even for non-Medicare products and services such as office supplies, building and construction services, software and systems support, etc.), including physicians, medical groups, hospitals, healthcare systems, ambulatory surgical centers, skilled nursing facilities, health insurance companies, etc.
-  Placement on the General Services Administration (GSA) Exclusions List (or "Debarred" List) from government contracting.
-  Loss of ability to contract or work for any individual or entity that contracts with the federal government in any capacity (officer agent, shareholder, director, employee or independent contractor, even for such services as construction projects, janitorial contracts, computer equipment and software services, real estate brokers on federally underwritten housing loans, sales of motor vehicles, products and services to the government, etc.

Click here to read more on the effects of being excluded.


Comments?

Have you ever been added to the OIG's exclusion list? Did you fight the allegations? Did you get reinstated? Please leave any thoughtful comments below.


Contact Attorney Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program and Assisting in Reinstatement Applications.

The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.


Tag Words: Exclusion list, Office of Inspector General, OIG, OIG exclusion list, reinstatement, investigations analyst, applying for reinstatement, Application for Reinstatement, Medicare Exclusion, OIG Hearing, Request for Reinstatement, Removal from List of Excluded Individuals and Entities (LEIE), Application to OIG, Medicare Reinstatement, defense attorney, defense lawyer, Florida defense attorney, Florida defense lawyer, The Health Law Firm

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
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George F. Indest III 9/10/2014

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