OIG Exclusion or Medicare, Medicaid Termination Can Ruin Your Professional Career

Monday, December 23, 2019
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Healthcare professionals:  Have you ever had discipline on your professional license during your career?  Have you ever been assessed a repayment or fine by Medicare or Medicaid Programs or had your participation in that program terminated or suspended?  Have you ever been convicted (or pleaded nolo contendere or had adjudication withheld) for a criminal offense?  If so, then you may have also been terminated or excluded from the federal Medicare Program or a state Medicaid program.  The consequences of such an action can ruin your professional career.

Check the Government’s List.

Your first step is to check if you are on the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) to see if you are on it. Click here to search the OIG exclusion database.

To see if you are on Florida's list of individuals and entities who have been terminated from the state’s Medicaid Program, click here to search the online database.

To check for possible termination from any other state's Medicaid Program, you will have to access that state's Medicaid fraud website. This can be done by searching "[your state's name] Medicaid fraud terminated provider list." The results should include the link to the Medicaid fraud health care providers' list for your state. However, many states do not maintain their list or rely on the federal government's LEIE.

If you have ever been licensed in another state, you should check the state's list to make sure action hasn't been unknowingly taken against you.

You should also do this for any and all of your employees, staff and independent contractors.  If they are on it, you should not be dealing with them at all.  It could cause you serious problems otherwise.

To learn more about the government’s list and what to do if you find yourself on it, click here to read my prior blog.

Long-Term Consequences to Your Career.

Termination or exclusion can have many collateral consequences that most health care providers are not aware of. For example, in some states termination from Medicaid Programs results in the loss of the health care provider's medical license completely.  Owning, being a shareholder, or being an officer of a business that is terminated by the state Medicaid Program, may result in the same treatment. Click here to read more about the consequences of OIG exclusion, investigations and other disciplines on your medical license.

If the health care provider is terminated by the state Medicaid Program, this is usually cause for termination of contracts with health insurers, other health care businesses or individuals, and termination of hospital clinical privileges.

Being terminated by the state Medicaid Program also causes exclusion from the federal Medicare Program.  This results in the health care professional being placed on the OIG’s LEIE list and on the federal General Services Administration (GSA) Debarment List.

What To Do If You Are On The OIG’s List.

If you find yourself on a state's excluded or terminated list or if you find yourself on the federal LEIE, all is not lost. There are ways to become reinstated. Most states and the federal government have applications that can be completed to be reinstated. The (OIG) in Washington, D.C., controls the applications for removal from the Medicare excluded list.

Since putting together such applications with all of the required documentation is not a simple task, we recommend that you retain legal counsel experienced in such matters.

To learn more about challenging Medicare and Medicaid termination and the steps you can take to challenge OIG exclusion, click here to read my prior blog.

How to Prevent It From Happening.

To prevent such action from being taken, you must receive timely notice of the contemplated action by the government agency.  However, to get this, your current address must be on file with all agencies with which you have a license, with any state Medicaid program you have been a participate provider in and with the Medicare Program.  Search the Internet and make sure your correct address is listed under your PTAN.  If you own a corporation or other business entity, make sure the current, correct mailing address, including any suite or apartment numbers, is on file with the state secretary of state.  Notices are often sent to obsolete or incorrect addresses and never received because they are not current or correct with all applicable government agencies.

Then, if you do receive a notice that termination is being initiated, immediately retain the services of an experienced health law attorney to request a hearing and challenge the termination.

Regardless of anything else, do not let the time outlined in the notice go by without requesting a hearing or an appeal or both, in writing.  This must be done in a form that provides you with documentation of sending and receiving your request, to be received by the agency providing the notice, before the expiration of the time outlined in the notice.  We often send such requests by two different methods to ensure that delivery is not delayed and occurs on time.

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.

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.

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