Monday, January 25, 2016

OIG Exclusion and Reinstatement of Excluded Individuals and Entities

One of the collateral consequences of criminal convictions for health care professionals is exclusion by the Office of Inspector General (OIG). The OIG exclusion list should be reviewed to confirm that the individual or entity is on it.

We have also seen individuals who were excluded and did not know it due to issues such as being in default of student loans.

One issue to understand is that reinstatement of excluded entities and individuals is not automatic once the specified period of exclusion ends. Those wishing to again participate in the Medicare, Medicaid (Medi-Cal) and all Federal health care programs must apply for reinstatement and receive authorized notice from OIG that reinstatement has been granted.

We have handed numerous reinstatement requests. OIG runs a background and one of the key issues is whether the individual or entity has been following the exclusion rules. We advise people to calendar 90 days before reinstatement period ends since the process can be started at that time. 

To apply for reinstatement, you cannot obtain the forms online. First, we send a written request to OIG to ask for the application for reinstatement.  Then once we received the OIG Statement and Authorization forms, we have the client complete them, add additional information as needed, and have the forms notarized and returned. 

The information contained in these forms will be evaluated and a written notification of OIG’s final decision on reinstatement is sent. Generally, this process takes 60 days but OIG claims it can take 120 days or longer.

Once there is OIG reinstatement, then the individual or entity can apply for reinstatement to Medi-Cal in California. This is a potentially lengthy process and involves an investigation and the process is not as structured as the federal side. Obtaining the OIG reinstatement is a must before this is done and it will take numerous contacts with the State to lift the Medi-Cal exclusion. Each state process is different - check your state laws and regulations if you are not in California.

Posted by Tracy Green, Esq.
Work 213-233-2260


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