OIG Exclusion: Do You Know if You’re on the List?

George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health La

Have you ever faced a disciplinary action against your professional license? Have you ever been arrested or convicted of a criminal offense? If yes, then you may have also been terminated from the federal Medicare Program or your state Medicaid Program.

Many health care professionals don’t think about the repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional career. Whether you are a physician, nurse, dentist, psychologist or other health professional, if you allow yourself to be excluded from the Medicare Program, devastating economic results may follow.

First, Check the List.

The first step is to check if you are on the federal government’s List of Excluded Individuals and Entities (LEIE). You can check that list here: http://exclusions.oig.hhs.gov/.

Next, to see if you are on Florida’s list of individuals and entities who have been terminated from Florida’s Medicaid Program, click here.

Collateral Consequences to OIG Exclusion or Termination.

Termination or exclusion can have many collateral consequences about which most health care professionals and providers are not aware. These Include:

– Termination for cause from all state Medicaid Programs.

– Loss of state professional licenses in other states and jurisdictions.

– Loss of hospital, ambulatory surgical center (ASC), and nursing home clinical privileges.

– Removal from the provider panels of health insurers.

– Loss of ability to contract or work for any individual or entity that contracts with the Medicare Program in any capacity. This includes physicians, medical groups, hospitals, healthcare systems, ambulatory surgical centers, skilled nursing facilities, health insurance companies, etc.

– Placement on the General Services Administration (GSA) Exclusions List (or “Debarred” List) from government contracting.

– Loss of ability to contract or work for any individual or entity that contracts with the federal government in any capacity.

To learn more on the consequences of being excluded, click here.

You’re On the List, Now What?

So, you just found yourself on a state’s excluded or terminated list or on the federal LEIE, don’t panic! All is not lost. There are ways to become reinstated.

The OIG exclusion list is a complicated regulatory program which requires experience and perseverance to navigate. It is highly recommended that you do not attempt to handle removal without qualified assistance. If your application is denied, even for hyper-technical reasons, you may be barred from reapplying for one full calendar year. Therefore, it is crucial that your application is complete and correct, and you are fully eligible for removal. To read a past blog about reinstatement after OIG removal, click here.

Contact Attorney Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program and Assisting in Reinstatement Applications.

The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

OIG Exclusion: What You Need to Know if You’re on the List

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Have you ever had disciplinary action against your license as a health care professional? Have you ever been arrested or convicted of a criminal offense? Have you ever been convicted of fraud or patient neglect? If so, then you may have also been terminated or excluded from the federal Medicare Program or your state Medicaid Program.

Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their career and employment. Whether you are a physician, nurse, dentist, psychologist or other health professional, if you allow yourself to be excluded from the Medicare Program, devastating economic results may follow.

Check the List.

To check if you are on the federal government’s List of Excluded Individuals and Entities (LEIE), click here.

To see if you are on Florida’s list of individuals and entities who have been terminated from Florida’s Medicaid Program, click here.

Collateral Consequences to OIG Exclusion or Termination.

Termination or exclusion can have many collateral consequences about which most health care providers are not aware. These Include:

– Termination for cause from all state Medicaid Programs.

– Loss of state professional licenses in other states and jurisdictions.

– Loss of hospital, ambulatory surgical center (ASC), and nursing home clinical privileges.

– Removal from the provider panels of health insurers.

– Loss of ability to contract or work for any individual or entity that contracts with the Medicare Program in any capacity (officer agent, shareholder, director, employee or independent contractor, even for non-Medicare products and services such as office supplies, building and construction services, software and systems support, etc.), including physicians, medical groups, hospitals, healthcare systems, ambulatory surgical centers, skilled nursing facilities, health insurance companies, etc.

– Placement on the General Services Administration (GSA) Exclusions List (or “Debarred” List) from government contracting.

– Loss of ability to contract or work for any individual or entity that contracts with the federal government in any capacity (officer agent, shareholder, director, employee or independent contractor, even for such services as construction projects, janitorial contracts, computer equipment and software services, real estate brokers on federally underwritten housing loans, sales of motor vehicles, products and services to the government, etc.

To learn more on the consequences of being excluded, click here.

You’re on the List, Now What?

If you find yourself on a state’s excluded or terminated list or if you find yourself on the federal LEIE, all is not lost. There are ways to become reinstated.

The OIG exclusion list is a complicated regulatory program which requires experience and perseverance to navigate. It is highly recommended that you do not attempt to handle removal without qualified assistance. If your application is denied, even for hyper-technical reasons, you may be barred from reapplying for one full calendar year. Therefore, it is crucial that your application is complete and correct, and you are fully eligible for removal. To read a past blog about reinstatement after OIG removal, click here.

Contact Attorney Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program and Assisting in Reinstatement Applications.

The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Exclusion list, Office of Inspector General, OIG, OIG exclusion list, OIG reinstatement representation, representation for physicians, representation for physician reimbursement, licensure defense attorney, professional license representation, licensure defense representation, representation for health care professionals, investigations analyst, applying for reinstatement, Application for Reinstatement, Medicare Exclusion attorney, OIG Hearing, Request for Reinstatement, Removal from List of Excluded Individuals and Entities (LEIE), Application to OIG, Medicare Reinstatement representation, Medicaid Reinstatement representation, healthcare fraud lawyes, Medicare defense attorney, Medicaid defense lawyer, Florida defense attorney, Florida defense lawyer, The Health Law Firm reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

New OIG Guidance Publishes on Permissive Exclusions from Federal Health Care Program Participation May Interest Mental Health Care Professionals

By Miles Indest, J.D./M.B.A candidate at Tulane University: Law Clerk, The Health Law Firm

On April 20, 2016, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released updated non-binding criteria that disclosed when a company or individual can be barred from participating in Medicare, Medicaid, and other federal health care programs.

The OIG has permissive authority to exclude a person or company from participation in federal health care programs for engaging in certain prohibited conduct, such as false claims or kickbacks. The OIG has consistently asserted that there is a presumption in favor of exclusion. The new guidance updates the OIG’s position by stating that its presumption in favor of exclusion is rebuttable in certain situations. Importantly, the OIG guidance outlines those situations and the risk factors that trigger an exercise of its permissive authority.

Four Factors May Affect OIG’s Decision to Exclude an Individual or Entity.

In its release, the OIG outlined four non-binding factors that signal a compliance risk and can affect its decision to pursue an exclusion: (1) the nature and circumstances of the prohibited conduct; (2) the conduct during the Government’s investigation; (3) any significant ameliorative efforts; and (4) the history of compliance.

First, the OIG will evaluate the nature and circumstances of the bad actor’s conduct. For instance, conduct that causes physical, mental, or financial harm to others increases compliance risk, thereby increasing the likelihood that the OIG will pursue an exclusion. Similar to the Department of Justice’s heightened focus on individual accountability, the OIG stressed that it will scrutinize an individual’s role in planning or leading unlawful conduct, which increases compliance risk.

Second, the OIG will assess the bad actor’s conduct during the Government’s investigation. If that person obstructed or impeded the investigation of the unlawful conduct, then the OIG will be more likely to pursue an exclusion. Notably, the OIG stated that a prompt response to a subpoena is “expected” and will not favorably affect the risk assessment.

Third, the OIG will weigh the bad actor’s ameliorative or remedial steps taken after the prohibited conduct occurred. For example, an entity that takes disciplinary action against individuals responsible or the conduct will lower its compliance risk. Similarly, individuals that receive new training or retain a mentor to improve their health care practice will face a lower risk of exclusion.

Finally, the OIG will focus on the bad actor’s history of compliance with the OIG. Importantly, the existence of a compliance program will not affect the risk assessment— likely another “expected” requirement of health care organizations. In contrast, the absence of a compliance program will increase compliance risk and the likelihood that the OIG will pursue an exclusion.

The OIG update ultimately reflects the government’s increased expectations of compliance programs and heightened scrutiny of individual wrongdoing. As federal agencies continue to prioritize the prosecution of fraud and abuse, health care organizations and practitioners would be wise to proactively address these concerns internally.

Contact Health Law Attorneys Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program and Assisting in Reinstatement Applications.

The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: Miles Indest, J.D./M.B.A. candidate, will graduate in May 2016 from Tulane University Law School and the Freeman School of Business. He has served three years as a member of Tulane Law Review, and currently serves as the Writing Skills Chair of Tulane Moot Court.

Sources:

“Criteria for Implementing Section 1128(b)(7) Exclusion Authority.” U.S. Department of Health and Human Services Office of Inspector General. (2016). Web.

Dani Kass. “HHS Watchdog Lays Out New Grounds For Exclusion List.” Law360. (2016). Web.

KeyWords: Health law, Office of Inspector General, exclusion list, defense lawyer, exclusion, OIG, OIG exclusion list, Florida defense attorney, reinstatement, application for reinstatement, OIG hearing,Medicare exclusion, Medicare reinstatement, Removal from List of Excluded Individuals and Entities, LEIE, Florida defense lawyer, defense attorney, The Health Law Firm

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

Kudos to Wyoming State Board of Nursing for its Accurate Information on its Website for Nurses

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

As a nurse, when you are the subject of a complaint that alleges improper conduct or action that could result in discipline against your license, finding correct information regarding the disciplinary process is vital. I’ve recently found that the Wyoming State Board of Nursing (BON) is one of the few nursing board websites that provide accurate information on discipline. On this website, there is information about  nurses’ legal rights, and explanations of the investigation or hearing process, for Advanced Practice Registered Nurses (APRNs), Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Certified Nursing Assistants (CNAs).

Click here to go to the Wyoming State BON website.

Wyoming State BON Website Provides Information Regarding the Board’s Duty of Reporting to National Practitioner Data Bank.

Information about nursing discipline actions was previously reported to the Healthcare Integrity and Protection Data Bank (HIPDB) by the Board taking action. The HIPDB collected reports made by federal and state licensing agencies, federal and state prosecutors, and federal and state government agencies that had excluded a practitioner, provider or supplier from their health plan.

On May 6, 2013, the HIPDB officially merged with the National Practitioner Data Bank (NPDB). The two data banks are now known as the NPDB. To read a blog on how this merger affects you, click here. For more information about NPDB, visit the website: http://www.npdb-hipdb.hrsa.gov/.

Wyoming Website Provides Information Regarding Actions by Office of Inspector General and the Exclusion List.

The Office of the Inspector General (OIG) has the authority to exclude individuals and entities from federally funded health care programs (Medicare, Tricare, Medicaid) and maintain a list of all currently excluded individuals and entities. This is called the List of Excluded Individuals and Entities (LEIE). Anyone who hires an individual or entity that is listed on the LEIE may be subject to civil monetary penalties (CMP).

The OIG has discretion to exclude individuals such as nurses or nursing assistants on a number of grounds, including misdemeanor convictions related to health care fraud (other than Medicare or a state health program); misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances; and purposes of disciplinary action by the Board including suspension, revocation or surrender of a license for reasons baring on professional competence or professional performance.

This means that if your license or certificate is suspended, revoked or voluntarily surrendered, your ability to be employed by a health care provider or facility that also receives federal funding, such as Medicare, may be precluded despite the statue of your licensure. In other words, once you are on the exclusion list and have not been taken off even after a reinstatement, you will not be able to be hired as a nurse or nursing assistant by medical facilities receiving federal funds.

To read more on the devastating and far-reaching effects of being excluded, click here.

The Wyoming BON website is the only one I have come across that accurately advises nurses of the collateral consequences of disciplinary action.

Legal Advice for Nurses in These Situations.

I want to commend the Wyoming State BON for including this information on its website. The information provides a great start for nurses with complaints against their licenses.

I’d like to offer up some additional advice. I encourage all nurses to buy insurance to cover license investigation legal defense expenses. Most nursing malpractice insurance policies are very inexpensive and provide excellent coverage. Most contain insurance coverage that will pay for an attorney and other legal defense expenses if you are being investigated or charged with a licensure offense. You should have at least $25,000 in coverage for such investigations and administrative proceedings.

Obtain an Experienced Health Law Attorney Immediately After Receiving Any Notification of an Investigation.

If the BON is investigating a complaint against your license, immediately obtain an experienced health law attorney to represent you throughout the investigation and disciplinary proceedings.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think of the information listed on the Wyoming State Board of Nursing website? Please leave any thoughtful comments below.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

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