Application and Removal from the OIG Exclusion List

Thursday, June 25, 2015
By Lance O. Leider, J.D.
The OIG exclusion list is a tool to keep track of individuals who have been excluded from participation in federal healthcare programs due to crimes or convictions like fraud or patient neglect. But individuals who are placed on exclusion lists by the OIG don't stay there forever. Each exclusion comes with a different term, and when that term is up, individuals may apply for reinstatement (and removal from the exclusion database).
Reinstatement doesn't occur automatically when the term ends. OIG-excluded individuals who wish to be removed from the Medicaid and Medicare exclusion list must go through a process to become employable in healthcare programs again.
How Do You Get on the List?
There are a number of ways a person can end up on the OIG's exclusion list ranging from student loan defaults to misdemeanor criminal convictions (even ones unrelated to healthcare) to out-and-out healthcare fraud, and everything in between. You can even end up on the list through a request of another federal agency. The problem then becomes, how do you get yourself off the list?
The official line from the OIG is that once a person is eligible for removal, he is required to request a Statement and Authorization Package from the agency, then fill it out and return it so that his background can be thoroughly investigated.
Knowledge is Power.
Knowing exactly when you are eligible for removal is not as easy a question as the OIG would have you believe. In the simplest of cases, it just means serving out the time of exclusion that was initially imposed. Unfortunately, it is becoming increasingly common for providers to be placed on the list without actually receiving notice. This means that you may not even know when, or for how long, you were placed on the list. It is very often the case that providers do not even know they are on the list until a prospective employer tells them they are not hireable because they are excluded. Click here to read a past blog about the effects of being excluded.
More Roadblocks.
Another serious problem is that removal from the list is often tied to the OIG getting some form of notice of eligibility from another federal agency. Which federal agency the notice comes from is not always easy to find out. Student loans are a great example of this. Unless you have settled your student loans with the Department of Justice, and notice of the settlement is sent to the OIG in a form the OIG deems sufficient (which it will not tell you), you are not eligible for removal.
The Bottom Line.
The OIG exclusion list is a complicated regulatory program which requires experience and perseverance to navigate. It is highly recommended that you do not attempt to handle removal without qualified assistance. If your application is denied, even for hyper-technical reasons, you may be barred from reapplying for one full calendar year. Therefore, it is crucial that your application is complete and correct, and you are fully eligible for removal. To read a past blog about reinstatement after OIG removal, click here.
Have you ever been added to the OIG's exclusion list? Did you fight the allegations? Were you able to get reinstated? Please leave any thoughtful comments below.

Contact Health Law Attorneys 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
About the Author: Lance O. Leider, J.D., is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
KeyWords: Health law, Office of Inspector General, exclusion list, defense lawyer, exclusion, OIG, OIG exclusion list, Florida defense attorney, reinstatement, application for reinstatement, OIG hearing, Medicare exclusion, Medicare reinstatement, Removal from List of Excluded Individuals and Entities, LEIE, Florida defense lawyer, defense attorney, The Health Law Firm reviews

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Response to: Application and Removal from the OIG Exclusion List
Saturday, July 2, 2016
C S says:

Thanks for your blog. It is helpful to understand this complex issue. I did have a question. For an exclusion 1128(b)(4) - License revocation or suspension. Minimum Period: No less than the period imposed by the state licensing. When can a excluded person petition to be removed from the exclusion list? My friend can't reapply for a state license until 3 years after the revocation/suspension. They don't want their license back but they do want to get off the OIG exclusion list. They can't work for pharma or biotech being on the list. When can they petition to be removed, after 3 years, 5 years or is there another answer?

Response to: Application and Removal from the OIG Exclusion List
Saturday, September 1, 2018
Bridget says:

How does someone not in healthcare end up on the OIG list? I am a patient that is all.

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