Being excluded by the HHS Office of Inspector General (OIG) can affect nearly every part of a healthcare professional's career. An exclusion can prevent payment from Medicare, Medicaid and other Federal health care programs for items or services you provide, order or prescribe.
Callahan Law's OIG Medicare attorneys represent healthcare professionals and entities facing OIG exclusions, appeals and reinstatement matters. If you received an exclusion notice, want to challenge an OIG decision or are preparing to seek reinstatement, our attorneys can help you address the process and protect your ability to work in healthcare.
What Does an OIG Exclusion Mean for a Healthcare Professional?
The HHS Office of Inspector General can exclude individuals and entities from participation in Federal health care programs. Once an exclusion takes effect, Federal programs generally cannot pay for items or services furnished, ordered or prescribed by the excluded person or entity. This reaches beyond personally billing Medicare or Medicaid and can affect work performed through healthcare employers, facilities and other organizations.
Excluded individuals and entities are also placed on the OIG's List of Excluded Individuals/Entities (LEIE). Healthcare organizations use the LEIE to identify excluded individuals and entities, which means an exclusion can create problems with current employment, new job opportunities, contracts and other professional relationships.
If you have received a Notice of Intent to Exclude, Notice of Exclusion or another communication from OIG, Callahan Law can review the notice and help you determine how and when to respond.
Why Does the OIG Exclude Healthcare Providers?
OIG exclusions generally fall into two categories under federal law: mandatory exclusions and permissive exclusions. The category and basis for the action can affect the length of the exclusion and the options available to challenge it.
Reasons for an OIG exclusion may include:
- Certain Medicare or Medicaid fraud convictions
- Other healthcare-related criminal convictions
- Patient abuse or neglect
- Felony convictions involving controlled substances
- License suspension, revocation or surrender
- Fraud, kickbacks and other prohibited conduct
- Default on certain health education loans or scholarship obligations
- Other conduct covered by federal exclusion laws
The specific basis listed in your OIG notice should guide how you approach the matter. It can affect whether there are grounds to challenge the exclusion, how long it may remain in place and what must happen before you can seek reinstatement.
Can You Appeal an OIG Exclusion?
OIG exclusions can be appealed, but the process depends on the type of exclusion and the notice you received. There may be an opportunity to submit information before an exclusion takes effect or challenge the exclusion through the administrative appeal process after OIG issues its decision.
An OIG exclusion appeal may involve a hearing before an HHS Administrative Law Judge (ALJ). An ALJ decision can potentially be appealed to the HHS Departmental Appeals Board (DAB), followed by judicial review when available under the applicable federal rules. Deadlines are an important part of this process. Our OIG Medicare attorneys can review your exclusion notice, identify the applicable deadline and determine what options you have for responding or appealing. Callahan Law can also prepare the necessary filings and represent you throughout the OIG exclusion appeal process.
OIG Exclusion Reinstatement Is Not Automatic
Completing your exclusion period does not automatically restore your eligibility to participate in Federal health care programs. You must apply for reinstatement and receive written confirmation from OIG that reinstatement has been granted before the exclusion ends.
For exclusions with a defined period, OIG currently allows individuals and entities to begin the reinstatement process 90 days before the exclusion period ends. Some indefinite exclusions, including certain exclusions connected to the loss of a healthcare license, have different reinstatement requirements.
Receiving a new Medicare provider number or enrolling with a health program does not end an OIG exclusion. Until OIG formally grants reinstatement, the individual or entity remains excluded.
How Can an OIG Reinstatement Lawyer Help?
Preparing for OIG reinstatement involves confirming that you are eligible to apply and completing the process required by OIG. When the original exclusion also involved a state professional license, there may be licensing issues that need to be resolved as part of your path back to Federal health care program participation.
Callahan Law can assist with the OIG reinstatement process by:
- Reviewing the original exclusion and determining when you can request reinstatement
- Identifying information and documentation needed for reinstatement
- Preparing and submitting your reinstatement request
- Responding to requests for additional information or documentation
- Addressing professional licensing issues related to the exclusion
- Helping resolve issues that could affect your eligibility for reinstatement
If you are approaching the end of an OIG exclusion period, you do not have to wait until the exclusion expires to start preparing. Callahan Law can review your situation and determine when the reinstatement process can begin.
OIG Exclusion Lawyers Serving Healthcare Professionals Nationwide
Because OIG exclusion is a federal matter, Callahan Law represents healthcare professionals and entities facing OIG exclusion, appeal and reinstatement matters across the United States. Our attorneys work with professionals throughout the country, including those practicing in Illinois, Indiana, Michigan, Wisconsin and Missouri.
OIG matters can also overlap with state professional licensing actions. A physician, nurse, pharmacist or other licensed professional may need to address both the federal exclusion and an action involving their state license. Callahan Law handles professional licensing matters in addition to OIG exclusion matters, allowing our team to identify when the two issues need to be addressed together.
Get Help With an OIG Exclusion Appeal or Reinstatement
If you have received an OIG exclusion notice, are considering an appeal or are approaching eligibility for reinstatement, Callahan Law can help you address the next stage of the process. Our attorneys represent healthcare professionals and entities in OIG exclusion appeals and reinstatement matters throughout the United States.
Contact Callahan Law for a consultation about your OIG exclusion, appeal or reinstatement.
