So…you're excluded. Your name is posted on the OIG's List of Excluded Individuals and Entities (LEIE), and the exclusion is following you around like a Scarlet Letter wherever you go, preventing you from working for or with any healthcare company that bills Medicare/Medicaid.
What exactly is the Process for Excluding Individuals/Entities?
The OIG's exclusion process is governed by regulations that implement sections of the Social Security Act. Keep in mind: "When an individual or entity receives a Notice of Intent to Exclude, it does not necessarily mean they will be excluded. The OIG will carefully consider all material provided by the person who recieved the Notice before making a decision."
For both mandatory and permissive exclusions the administrative process is the same. The OIG sends out a written Notice of Intent to Exclude which includes the reasons for exclusion and the its effects. Remember, the notice is just a notice and allows the individual 30 days to gather information or evidence on whether or not the exclusion is warranted. Then and only then will the OIG make a final decision on whether or not to grant the exclusion.
If the OIG decides to proceed with the exclusion a Notice of Exclusion, along with the repercussions of the exclusion and appeal rights, is sent to the individual. The exclusion is effective 20 days after the Notice is mailed.
But there is some good news…in most cases, you can be reinstated. There are ways to get off the list, but it does require proactive action on your part.
IMPORTANT: Reinstatement of excluded entities and individuals is NOT an automatic process once the specified period of an exclusion ends. Most exclusions have a specific term length, often 5 years. At the end of your OIG exclusion term, you MUST apply for reinstatement and receive an authorized notice from the OIG that your request was granted. Only then will you be able to participate in all Federal healthcare programs (like Medicare and Medicaid).
Excluded providers may ONLY begin the process of reinstatement 90 days before the end of the excluded period. Premature requests for reinstatement will NOT be considered, so be mindful of when you can apply.
Here's the step by step process of applying for reinstatement:
1. To apply for reinstatement, send a written request to the OIG at the address below:
Washington, D.C. 20026
This process typically requires up to 120 days to complete, but can take longer (and has).
If the OIG grants your written request for reinstatement (and provides you with a notice in writing), then you're off the list! However, it's always good to double-check. If the OIG denies your written request for reinstatement, you may reapply and redo the whole process after 1 year.
While the process of reinstatement can be long and arduous, following the established procedures in order (and at the right point in time) can effectively get your name off of the OIG exclusion list.
Simply follow directions, fill out the forms in their entirety, and don't apply before 90 days prior to the end of your excluded term, and you should be ok.
Now you know that exclusions do not automatically expire, a reinstatement is required and how the exclusion process works.
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This post was originally published March 6, 2015 and has been completely revamped and updated for accuracy and comprehensiveness.
Written by Michael Rosen, ESQ
ProviderTrust Co-Founder, firstname.lastname@example.org
Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as: Inc Magazine's Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year
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