Fight Office of the Inspector General (OIG) Exclusion!

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

Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (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.


OIG Action May Follow After:

 

-  Disciplinary action taken against a state license;

-  A criminal conviction or nolo contendere plea;

-  An adverse clinical privileges action by a hospital or other entity with a peer review process;

-  Revocation of a Drug Enforcement Administration (DEA) registration;

-  Termination for cause by a state Medicaid Program;

-  Suspension of a state license;

-  An unpaid final order or judgment in a Medicaid audit or recovery case;

-  Failing to repay your student loans or HEAL loans; or

-  Voluntarily relinquishment of a state license after an investigation has been commenced. (Note: This is treated the same as a disciplinary revocation.)

The Exclusion Process.

The process to exclude you from the Medicare Program and place you on the List of Excluded Individuals and Entities (LEIE) will begin with a simple, innocuous looking letter from the OIG sent by regular U.S. mail. In some cases, the deadline to respond may have already passed. In many instances you may be so depressed by all of the events that have lead up to this that you feel mentally unable to fight it. Do not ignore this. Do not give up. Fight it!


Responding to the OIG Letter.

You must respond, even if the time has passed when you receive the letter; simply explain when you first received the letter and why the response is late.
Request a hearing if a hearing is afforded to you. Submit documents and information to show why you should not be excluded.

MOST IMPORTANTLY, consult a health law attorney experienced in such matters. The consequences of a Medicare exclusion, even a permissive exclusion for one year or three years, are severe. Most people do not realized this until it is too late; then it is too late (in many, but not all, cases).


Adverse Consequences of Exclusion by the OIG Include:

-  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.

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

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.


Comments?

Have you every faced exclusion from the Medicare Program? Please leave any thoughtful comments below.


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:  Office of Inspector General (OIG) Exclusion, 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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Comments:

Response to: Fight Office of the Inspector General (OIG) Exclusion!
Thursday, October 24, 2013
Rick says:

Facing mandatory exclusion due to pending drug diversion felony charge. This due to addiction after painful surgery. No distribution, nothing else. No rehabilitation for addiction here. You are out! Not helpful to the hundreds or thousands of impaired professionals. Who will self report or ask for help? Addicts don't choose this dilemma, they are sick! Question, if your medicare credential is terminated, can you still be excluded? Thank you

Response to: Fight Office of the Inspector General (OIG) Exclusion!
Sunday, May 18, 2014
Amy says:

You can get on this list just for dusciplinry licensure action. I never got into legal trouble, but lost me license due to alcoholism. Did not even realize I was on this list until 2 years later when a job offer to work at bcs was rescinded. This list was initially created for people who intentionally defrauded the government. Sadly the majority of the people on it now are sick, not criminal. It is a shame and truly sad that our government allows people who are a protected class to be in this "blacklist". Talk to a lawyer, the right one can get you off of it even without reinstatement of your license (which the boards would have you believe is impossible). It is expensive but worth it. Here ' shooing one day the OIG will get calked out for this farce

Response to: Fight Office of the Inspector General (OIG) Exclusion!
Monday, June 23, 2014
Lisa M. Lopez says:

I can't believe everything i am reading here is talking about me. My God, someone understand what I'm going through. Office of Inspector General ruined by life and I didn't even know it. I have been through hell for dealing with the exclusion list. They had really damaged me so bad. My spirit has been broken. Interesting, I've called many support groups online for nurses that has got into trouble. Hardly any of them really know what Office of Inspector General is. Pretty scary. Only one counselor told me he only heard one incident of a doctor being on the exclusion lists. He told me "You know, you really spark my interest for the next meeting" I wonder how many know they are on the list?" I thought this was really scary thought. What a sad invasion of privacy, to have this ruined our careers. Thank you for letting me vent my feelings.

Response to: Fight Office of the Inspector General (OIG) Exclusion!
Wednesday, July 2, 2014
The Health Law Firm says:

Lisa and Amy, We are so sorry this happened to both of you. Unfortunately, your stories are all too familiar. Exclusion can have devastating consequences for health care professionals and providers. We have experience in dealing with the OIG, in 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). If you'd like to discuss your situations with at attorney you can call our office at (407) 331-6620.

Response to: Fight Office of the Inspector General (OIG) Exclusion!
Wednesday, May 18, 2016
Valerie fuentes says:

Need help, don't know if I have a chancertain to fight an exclusion

Response to: Fight Office of the Inspector General (OIG) Exclusion!
Wednesday, September 12, 2018
Haley says:

I am already on the list, is there a way off of it?

Response to: Fight Office of the Inspector General (OIG) Exclusion!
Wednesday, November 7, 2018
Candace E Sterling says:

Need to know if I have a case for an appeal. Just had a pre-appeal via telephone. Have questions that needs to be answered.

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