Being Excluded from the Medicare Program and Placed on LEIE Carry Many, Many Adverse Consequences for Future Employment

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

If you surrender your state license, or even your privilege to practice in a state, to evade an investigation or complaint, the state licensing authority is obligated to report this to the National Practitioner Data Bank (NPDB). This is the same for Veterans Administration (VA) physicians and employees, as well as for military physicians and employees.

When the report is received by the NPDB, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) receives a copy of it. The OIG will then send you a letter to your last known address of record advising you that it intends to exclude you from Medicare and other federal healthcare programs. These “other” federal health care programs include Medicaid, Tricare, VA, and many other programs that are funded in any part with federal tax dollars.

If you receive such a letter, you need to hire an experienced attorney and challenge it. You only have a very short deadline in which to do this, often 30 days or less.

The List of Excluded Individuals and Entities (LEIE).

When this occurs, your name will go onto the List of Excluded Individuals and Entities (LEIE) and will be there for the rest of your life, unless you file an application for removal from the LEIE.

Additionally, you are also excluded from working for any other business or healthcare professional, or entity that accepts federal healthcare funds, whether as an employee, an independent contractor, a consultant, or an adviser.  Some states even prohibit the issuance or renewal of a license if you are on the LEIE.

Employers or contractors accepting federal healthcare funding must check the LEIE before hiring or contracting to ensure individuals and companies are not on the list.

Therefore, if you are placed on the LEIE, you should hire an experienced attorney and seek removal from it at the earliest possible time.

You Will Also Be Barred from Other Federal Government Contracting.

Unfortunately, if you are placed on the OIG’s LEIE, you will also be placed on other government lists of individuals who are barred from participating in any way with any government contracts that are awarded to anyone.  This includes the “Debarred List” or Contractor Exclusions (or “SAM”) List maintained by the General Services Administration (GSA).  The VA checks this and has input to this list as well.

Implications are Severe.

This means the implications are severe; if placed on the LEIE and excluded from Medicare, you will automatically go onto the GSA’s SAM list. You will not be able to obtain or maintain any employment with or contracting with any of the following:

Any health insurance company contracting with the government (virtually all of them);
The U.S. military or Department of Defense (DOD);
The Veterans Administration (VA);
Any school system that accepts federal funding of any type;
Any hospital or healthcare organization that accepts federal funding of any type;
Any real estate broker or other company involved in federally backed housing loans;
Any organization that contracts or subcontracts with one of the above.

 

What You Should Do.

Consult with any experienced healthcare attorney prior to making a decision to give up a professional license when notified of a complaint or an investigation.
Keep a valid, current address at which you actually receive mail on file with all of your professional licensure boards, even if your license is expired.
Consult with an experienced healthcare attorney to respond to any letter from the OIG to challenge the decision and request a hearing.
If you are on the LEIE, apply for removal at the earliest possible opportunity, using the services of an experienced healthcare attorney.
The attorneys of The Health Law Firm are available to represent you in any of the above matters anywhere in the world.

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. They have also submitted 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 toll-free at (888) 331-6620 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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

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