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oig exclusion list

Posted
stersgal stersgal (New) New

can anyone give me some advice on how to get off the medicaid exclusion list. i dont have and end date on my paperwork. it says indefinite. i dont have 3 thousand dollars for a lawyer that can promise me to get me off it. any insite will be greatly appreciated

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

I've had the responsibility for checking 10,000+ physicians monthly for OIG sanctions so this is what I've learned over the years.

Defaulting on student loans was the #1 issue physicians in my area placed on OIG list followed by drug convictions.

Exclusions - Office of Inspector General - HHS

OIG has the authority to exclude individuals and entities from Federally funded health care programs pursuant to sections 1128 icon_leavesite_gray.gif and 1156 icon_leavesite_gray.gif of the Social Security Act icon_leavesite_gray.gif and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals and Entities (LEIE). Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP).

Exclusions are imposed for a number of reasons:

Mandatory exclusions: OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.

Permissive exclusions: OIG has discretion to exclude individuals and entities on a number of grounds, including misdemeanor convictions related to health care fraud other than Medicare or a State health program, fraud in a program (other than a health care program) funded by any Federal, State or local government agency; misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances; suspension, revocation, or surrender of a license to provide health care for reasons bearing on professional competence, professional performance, or financial integrity; provision of unnecessary or substandard services; submission of false or fraudulent claims to a Federal health care program; engaging in unlawful kickback arrangements; and defaulting on health education loan or scholarship obligations; and controlling a sanctioned entity as an owner, officer, or managing employee.

The effect of an exclusion is that no payment will be made by any Federal health care program for any items or services furnished, ordered or prescribed by an excluded individual or entity. No program payment will be made for anything that an excluded person furnishes, orders, or prescribes. This payment prohibition applies to the excluded person, anyone who employs or contracts with the excluded person, any hospital or other provider for which the excluded person provides services, and anyone else. The exclusion applies regardless of who submits the claims and applies to all administrative and management services furnished by the excluded person.

It all depends on reason placed on exclusion list as to length of penalty and when you can apply for reinstatement. You can start the process 90 days prior to end of suspension. It is always wise to seek legal counsel to protect your rights.

Check out The American Association of Nurse Attorneys. If you have malpractice/professional Liability Insurance, see if your policy provides representation.

Applying for Reinstatement

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

Best wishes resolving this issue.

Thank you although I was never given a date. It just says indefinite? How do I know when to apply for reinstatement

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Check your exclusion notice, as it notifies the party of the exclusion, its effect and information concerning appeal rights.

You can contact OIG Exclusions program

The Frequently Asked Questions (FAQs) provide answers to a variety of questions typically asked regarding the OIG Exclusion program. Please review the FAQs before contacting the OIG.

If you do not find an answer to your question regarding content and information contained in the LEIE, contact the Exclusions Staff at:

[TABLE]

[TR]

[TD] E-mail Address:

sanction@oig.hhs.gov

Telephone:

(202) 691-2311

Fax:

(202) 691-2298

Email:

sanction@oig.hhs.gov[/TD]

[TD=width: 60%] Mailing Address:

HHS, OIG, OI

Attn: Exclusions

P.O. Box 23871

Washington, DC 20026[/TD]

[/TR]

[/TABLE]

I've left a message and sent email to above contacts thank you. Do you know why I don't have an end date? Is this common? Do you see indefinite as a date often

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 40 years experience.

Again, I think it's related to the REASON you're on the list.

WIth the OIG have you seen medical professionals that have appealed their exclusions and won? have you see this when dealing with fraud? I am being investigated for medicare fraud and reviewing the laws of OIG just because a motion is filed the OIG could exclude me even if the charges are dropped. just curious to see what your opinoin is on all of this. thank you