OIG appeal

Published

Hello-

I have practiced nursing for 5 plus years and part time I worked as a private duty nurse. I eventually left a case and due to my mental health and extreme binging and purging and spending up to hundreds of dollars a day, I did indeed get myself into some trouble with billing. I look back now and think what did I do, and at the time I wasn't in my right mind, I was obsessed with my illness and even as a nurse didnt think my binging and purging was that big of a deal and that I had it under control. I didn't, and I am ashamed of the mistakes I have made because deep down I know I am a good nurse. Good people make terrible mistakes and prior to this I have never been in trouble before. It makes me sad that I did this within a profession I love and value and I could lose it all. So I am someone currently being investigated for medicare fraud, I have a lawyer who has talked to my state's assistant attorney general who is willing to discuss and most likely reduce my charges down to a misdemeanor of theft as long as I keep getting the help I need and probation. My biggest fear is now the OIG. I know it is early in my case but I am wondering if anyone has ever appealed the OIG and has had success? especially in cases like mine. I know I screwed up big time and if I didnt get investigated now I would not be getting the help I need for my eating disorder and my mental health. And if you are on the exclusion list did you give up your careers in nursing or what are you doing for employment now?

Thank you

NRSKarenRN, BSN, RN

11 Articles; 17,560 Posts

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 46 years experience.

Many personal care assistants and nurses are unaware that submitting billing statements for hours of care not actually provided to clients/patients is Medicaid/Medicare fraud: leaving early from shift care worked 10hrs, billed 12hrs as scheduled shift)), home care staff providing care to client in hospital or billing for shift hours not provided while client hospitalized, billing for Skilled nursing visit not made to keep visit pattern intact.

Previous thread: OIG Exclusions List + affect on nurses ability work

How does an excluded individual or entity get reinstated?

Reinstatement of excluded entities and individuals is not automatic once the specified period of exclusion ends. Those wishing to again participate in the Medicare, Medicaid and all Federal health care programs must apply for reinstatement and receive authorized notice from OIG that reinstatement has been granted.

To apply for reinstatement, send a written request to OIG at the address below. OIG will then provide Statement and Authorization forms that you must complete, have notarized, and return. The information contained in these forms will be evaluated and a written notification of OIG's final decision on reinstatement will be sent to you. Generally, this process requires up to 120 days to complete, but can take longer.

Excluded providers may begin the process of reinstatement 90 days before the end of the period specified in the exclusion notice letter. Premature requests will not be considered.

If reinstatement is denied, the excluded party is eligible to reapply after 1 year.

To apply for reinstatement, send a written request to:

HHS, OIG, OI

Attn: Exclusions

P.O. Box 23871

Washington, DC 20026

(202) 691-2298 (Fax)

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