MediCAL Exclusion List, but NOT on OIG

LawkieRN · Feb 2

Hello hi I am going through the same situation and I have been sending letters out to each and every board trying to find which one can help. I am not sure if your in the same state or process of trying to get this removed. Hopefully we can help in this journey. It is too much but yet another hurdle after being disciplined by the board of nursing.

Maria Jones-Rebulloza · Mar 11

For surrendering your LVN license it willl affect your RN license. But it's only a mandatory 1 year suspension and then all you have to do is request to be removed from the medical sanction list

"There are no forms – all we require is a request asking to be removed from the S&I List in writing/email.”

[email protected]

email them with a screenshot of you active RN license and ask to be removed from the list

LawkieRN · Mar 11

Hello I really appreciate the information. I actually applied and was taken off and all my license #'s included on the the letter. It was a stressor because I was calling all around medicaid and medicare hotlines, OIG, Samsa etc and they did not know what I was talking about. I was taken off the list in Feb. thank you again!!

I really appreciate you responding.

Maria Jones-Rebulloza · Mar 16

So happy I was able to help!

T Rog · Oct 11

Can I ask- you wrote a letter to the email above ([email protected]), and how long did it take for them to remove your name from the list?

I have a default order revocation on my California license from failure to respond to a board inquiry. I had attempted to update my address in the breeze system, and it appeared to take but didn't. Naturally I never received correspondence, and California issued a default revocation in April of 2023. Can't apply for reinstatement until 2026, but the issue they were trying to contact me about has been dealt with as is no longer an issue.

Hoping I can at least be removed from the list.

JB C · Oct 12

Thankfully you didn't end up on the Office of Inspector Generals Exclusion List which is from the FEDERAL Government. Medicaid Exclusion Lists are from individual states. If you are an APRN, the odds are overwhelming that if go on a STATE Exclusion list such as Medicaid you do end up on the FEDERAL OIG list and there's no getting off it until about 5 years. If you are an RN you end up on the Federal List (OIG) about 50 percent of the time. If you are an LPN, you end up about 1/3rd of the time on the OIG list.

The OIG gets its recommendations/reports from the state Medicaid Exclusion lists. If you go on any state Exclusion list, then they automatically (by law) report this to the OIG (Feds) and the Feds (OIG) makes a decision to put you on their list or not. You are very fortunate. Getting off of state exclusions lists (Medicaid) is very easy once your nurse license is back in order and restored, but even once you get off of the stste Exclusion list and giving the proof of this to the OIG (Feds), it is still often a minimum 3 year ban

T Rog · Oct 12

So an update. I emailed the above mentioned email. I showed them proof of 4 other state licenses, which are unencumbered. Within 24 hours I received an email from DHCS stating that my request to have my name removed from the Medi-cal list has been granted, and that my name will be in removed in 10/24/24.

Quite literally the fastest administrative resolution I've ever seen in my nursing career. I was panicked because I kept reading that it could take a year to a year and a half.

T Rog · Oct 12

And just as an adjunct- having your license reinstated is NOT mandatory to get off of the Medi-cal list. They actually said that to me when I initially emailed them. My license in California is still revoked until 2026, but I have 3 other states who have issued me licenses in the last 2 years, in spite of the California revocation. I think it's entirely situational.

JB C · Oct 12

T Rog said:

And just as an adjunct- having your license reinstated is NOT mandatory to get off of the Medi-cal list. They actually said that to me when I initially emailed them. My license in California is still revoked until 2026, but I have 3 other states who have issued me licenses in the last 2 years, in spite of the California revocation. I think it's entirely situational.

Congrats. Having your license reinstated is NOT mandatory to get taken off of the State Exclusion List, BUT.....it is usually required. If your license is reinstated, you will generally get off. In the rare situation that you get off of the list and still don't have a reinstated nursing license, you must meet many requirements.

If you were on the exclusion list for drugs or alcohol. You will need to show proof that you have gone through a PHP, IOP, and Aftercare program (takes about 15 months) and have a letter from an addictionologist saying your SUD is in full remission. Most nurses do not meet this requirement, so they remain on the exclusion list.

If you were excluded due to a criminal offense and your nursing license has not been reinstated yet, you can get off of the exclusion list if your criminal case is resolved and you went through something like pretrial intervention or charges dropped or some diversion program where the case is no longer active and you have proof with the final official court disposition.

So yes, technically you do NOT have to have a reinstated nursing license to get off of the state exclusion list, but......in a way, you kind of do unless you can meet and prove the strenuous requirements listed above.

T Rog · Oct 13

I'm not surprised. The discipline cascade is a bit ridiculous all the way around. Nursing boards are so backed up, that it takes them years to get around to issuing disciplinary actions. Years elapse, and then the nurse, the event, everything surrounding it is cloudy in memory. I really think there needs to be a statute of limitations in administrative law, or more leniency in permitting laches defense. It would force professional boards to prioritize the critic nature of complaints. The way it is now, they are given an endless timeline to process every complaint that lands on their desk. They are also given extensive immunity to any civil prosecution. I understand the reasoning for this, but it also ruins lives, reputations, careers etc. The way it's setup currently, permits the board to issue discipline 5 years down the road. You can have a minor infarction, lose a job, suffer the blow, go on to further your career, not make another mistake and suddenly 5-6 years later you're faced with the charges from that mistake being thrown in your face again and a pending board investigation/sanction. Sometimes you can be disciplined by one board for a minor infarction, then a board in another state (where you have an inactive license from years prior) decides 4 years later to issue an action based on the original state's action. It becomes the cyclical game of never living down your mistake. They don't do this to doctors. My attorney told me that he would rather deal with the medical board all day long, then spend 10 minutes with the board of nursing.

I'm happy and fortunate I didn't land on the OIG list. That's a nightmare. Luckily my revocation was a default order for lack of correspondence. I had to wait a year before I could petition to come off the medi-cal list, but I think the nature of my revocation, coupled with my active licenses in other states gave me an advantage in a quick request granted by DHCS. I get to now try to navigate reinstating my California license in 2026. Yay... Fun times. I may just decide not to bother. I have no intention of moving back to California, and the license being revoked hasn't kept me unemployed in any other state, so.... I hate seeing that I have a revoked license, but I hate dealing with the BON even more. We'll see I guess.

JB C · Oct 13

Your statement is 100 percent spot on. The fact that this is not as common with physicians/medical boards rests in physicians being objective, rational thinkers instead of nurses which is so commonly, "emotion based." We see it on this board. We see it at work. We see it with the state boards. When you are heavily emotion based, common sense dissipates. When you are objective and rationale like physicians, common sense dominates. The reason for this is because nurses are the front line for patients with providing compassion and caring in addition to the science part of our profession. Compassion and empathy are emotional based and important, so we have to be emotionally based, but the downside is that it can interfere with other rational and practical/objective thinking. Common sense gets lost, and we get State BONs bordering on foolishness.

That's the biggest adjustment for nurses going on for an APRN (NP, CRNA, etc) and it's that transition from emotional based thinking to more objective/rational based thinking and it causes lots of nurses major problems in school. I'm not knocking nurses who don't have APRNs either, but I can say this. Most BON members are not APRNs. If they were, they wouldn't be on the Board, they would be practicing. A few of them are, but most are not. You are dealing with tons of emotional based decisions and trying to reach them mentally and convincing them of data and objective thought is like pouring water on an electrical circuit. It does not work. It's why physicians often make jokes about nurses or belittle us or why lawyers have distaste for the BONs compared to Medical Boards. It's not because they think we are stupid. It's because of our emotional based thinking that in reality, isn't reachable by evidence. Most nurses on the BON have never taken a graduate level research class. They don't have a clue how to read and decipher a research study. They can read the abstract and what the abstract says, but not have a clue about power, effect size, normal distribution, and can only take the abstract at its word as 100 percent gospel, not knowing whether the methods to reach the conclusions presented in the abstract are solid or garbage.

What does a nurse on the Board do when something like this is explained? One would think they would become more practical, rational, and objective, but they don't. They only know what is ingrained in them and they double down on the emotion based thinking and rinse and repeat.