Medicare and Medicaid Exclusion Appeals and Reinstatement Applications

You may be excluded from the Medicare and Medicaid programs for any number of reasons.  A criminal conviction is one of the most common reasons healthcare professionals find themselves on the exclusion lists.  But you may also find yourself excluded from the Medicare and Medicaid programs based on a professional discipline complaint or a Medicare or Medicaid audit.

You may be placed on the exclusion list by the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services.  Or you may be excluded from a Medicaid program by the New York State Office of Medicaid Inspector General (OMIG).  Either way, being on the excluded list can destroy your career.  You will not be able to bill any federal healthcare programs for as long as you are the list, and you will not be able to work for any healthcare providers that bill Medicare or Medicaid.

Exclusion from Medicare or Medicaid often results in the termination of contracts with health insurers, the termination of contracts with other health care businesses or individuals, and the termination of hospital clinical privileges.

The exclusions may cover different time periods.  For example, OMIG may exclude you now for a period of five years.  Then, two years from now, OIG may exclude you for the same reason for another five years.  As a result, your “five-year” exclusion could actually last seven or more years.  Exclusion by the OIG will also place you on the federal General Services Administration (GSA) Debarment List, which means you will not be able to work or contract with anyone who contracts with the government or receives government funds.

How to Respond to an Exclusion from Medicare or Medicaid

If you receive a notice that OIG or OMIG may exclude you from Medicare or Medicaid, you must act quickly.  Your deadline to respond and appeal is very short – you have as little as 30 days to prepare your evidence and present it – and that deadline is strictly enforced.

If you are already excluded, you may apply for reinstatement.  You must be able to show that you have complied with the exclusion and that you have not engaged in any further conduct that would justify exclusion.  If you were required to pay a fine or restitution, you must pay the money or work out a payment plan before applying for reinstatement.  It is also helpful to support your reinstatement application with letters and testimonials from patients, colleagues, and community leaders to show that you have been rehabilitated and are making a positive contribution to the community.

You may apply for reinstatement only once each year, so you must make sure your reinstatement application is thorough and professional.  Retaining an experienced Medicare and Medicare fraud lawyer can often make the difference between success and failure.

John Howley Esq. has more than 27 years of experience representing professionals in complex healthcare matters including exclusion appeal and reinstatement applications.  Call him directly at (212) 601-2728 to schedule a consultation.