Seven Things To Know When You Receive A Notice Of Investigation From The Department Of Health

Requests for Reinstatement to Medicare Program, Request for Removal from List of Excluded Individuals and Entities (LEIE), and Other OIG Actions

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).

For an example of a letter from the Office of the Inspector General (OIG) granting a request for reinstatement to the Medicare Program after exclusion and granting removal from the List of Excluded Individuals and Entities (LEIE), from an application that we submitted for a health professional to the OIG, click here.

Exclusion from the Medicare Program can have devastating and far-reaching consequences that an individual may not even contemplate happening. 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.

It is important to fight any action commenced to suspend or terminate your participation in the Medicare Program or to exclude you. It is important to attempt to petition to have your exclusion from the Medicare Program lifted if this has happened. It is extremely important to have representation by a competent, effective health care attorney with experience in these matters to represent you.