Saturday, July 6, 2013

How Do I Get Reinstated To OIG For Medicare After My Exclusion Period Has Ended?

One of the frequent issues we handle is OIG exclusion following a conviction for health care related offense.  An OIG exclusion bars a health care provider from working with any provider that received any federally funded program funds. For example, if an individual received a 5 year OIG exclusion, he or she cannot work as an employee, independent contractor or volunteer for any Medicare provider with some very limited exceptions for that time period. However, after the 5 year period it is important to know that reinstatement is NOT automatic.

We have assisted clients over the years with their OIG reinstatement. Here are a couple of facts to know. First, there is no way to obtain early termination of the exclusion time period once it has been effective. If you received an OIG exclusion notice, it is important to submit information at that time to help make sure that the period will not be longer than the minimum 5 years. If you fail to submit information at that time, you will not be able to do it later. The only exception is for emergency services. There is an appeal process.

For example, OIG sent a notice to one of our clients that because a former owner was excluded by OIG, that entity was going to be excluded. We submitted proof that the entity had been sold, that the former owner was no longer involved and that the entity should not have been excluded. If that information had not been provided within the first 30 days, then the entity would have been excluded and lost its right to appeal. Thus, if there is an exclusion letter received, act on it right away.

Second, if you have been excluded, you can begin the reinstatement process 90 days before your exclusion period is to end. If we send the reinstatement package before that date, it will not be considered.

Third, there are a number of factors that OIG considers in determining reinstatement. One of them is whether you have been providing services to Medicare providers during your exclusion period. This also includes management and administrative services. There will be a request for information as to all places you have worked and or provided services. OIG also conducts a background check. 

Fourth, remember that in California even if you are reinstated by OIG, you also have to seek reinstatement from the Medi-Cal program. When Medi-Cal issues a suspension following a conviction, it is lifetime and you must seek to be reinstated. It is best to start this process after you have been reinstated by OIG as that is an additional ground for lifting the suspension.

This is only a starting point but it is important to remember the rules regarding OIG exclusion. If an OIG excluded provider works with any Medicare or Medi-Cal provider, that provider will be strictly liable for having to repay those funds. It can also subject the excluded provider to civil penalties.

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
Office: 213-233-2260


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