OIG Medicare Exclusion Attorney

OIG Exclusion Defense

Have you been placed on the Office of Inspector General (OIG) Exclusion List (LEIE) and would like assistance in removing yourself from the List?  Chelle Law assists health care professionals in either fighting the Notice of Intent to Exclude or requesting the removal of the health professional if they are currently on the exclusions list. Legal representation is your best choice if your desire is to be removed.

Medicare Legal Exclusion by OIG

So, what does it mean to be on the exclusion list? It’s important to know what the Exclusion List is as well as what it means to be on it. The Office of Inspector General keeps a list of all individuals or entities that are excluded from participating in Medicaid, Medicare, and other health programs. This list is called the LEIE or List of Excluded Individuals/Entities. The public, patients and everyone in the health care industry can thereby stay informed about exclusion and take necessary action after investigations. Popular exclusion questions include:

The OIG takes into consideration sections of the Social Security Act in order to determine whether or not someone will face exclusion from the programs (including Medicare). When they decide an individual or entity should face exclusion, they will send them a Notice of Intent to Exclude. This doesn’t mean there is an exclusion. The person who is receiving the notice can provide materials which the OIG will carefully consider before moving forward. The person who is receiving this notice has 30 days to gather the information to explain why the exclusion is not warranted.

When you are going to be placed on the LEIE, the OIG will send a Notice of Exclusion with an explanation of the details of the exclusion, as well as your appeal rights. Once this is mailed, the exclusion becomes effective 20 days later. When your organization or you have been put on the exclusions list, it means that you won’t be able to participate in health care programs such as Medicare and Medicaid any longer.

It is possible to be reinstated and get off the Exclusion List. It takes some work, but it can be done. First you would appeal it to an HHS Administrative Law Judge. If getting an adverse decision there, you can then appeal it to the HHS Departmental Appeals Board also known as the DAB. If not happy with the final decision of the DAB, you can then get a judicial review done in Federal Court. Specialized attorneys offer their services and can help with the appeals. A health law attorney who knows health law is the best bet to give you the best chance of winning an appeal.

If an individual has exclusion under section 1156 of the Social Security Act, he or she can request a hearing if program services are being delivered to more than 50 percent of that person’s patients and in a rural area where there is a shortage of health professionals delivering services. When the individual has received a written notice of exclusion, he or she may file a request in writing for a hearing before the HHS Administrative Law Judge within 15 days of when the notice was received.

What is a Medicare Exclusionary Screening?

So, what is an IG screening, also known as Medicare exclusion screening? OIG screening is a process to verify whether or not a potential or current employee is on the Exclusion List and not allowed to participate in any way with a health program. There are no warnings or notifications issued that tell of exclusion. Exclusions are something that needs to be checked regularly.

The Exclusion List is compiled by the Office of IG. It includes all entities or individuals who are not allowed to participate in any health care program with Federal funding. This includes Medicare and Medicaid programs. The list is called the List of Excluded Individuals/Entities.

It is necessary for any employer to search the database maintained by the IG, SAM.gov and any state Exclusion database. Each employee, contractor, subcontractor or new hire needs to be screened in this way, so that if they are on the Exclusion List, they are not hired or continued in employment.

The employer puts the name of the employee and his birth date into the database. Anyone with a similar name will show, and the employer needs to verify whether it is his employee or not. All variations of names need to be checked, including maiden names, as well as name diminutives (such as Jimmy instead of James). The results gotten can be cross-checked with the employee’s social security number and birth date.

How Often Should You Screen for Medicare Exclusion?

The screening, for exclusions from the list and including Medicare exclusion, should be done every month, as names get removed when appealed or in other circumstances. If it is impossible to do monthly, it should be done as often as possible. IG updates the list monthly. Another option is to hire a vendor to do the screening. It is definitely a labor-intensive action, particularly for large companies. There are particular people that should be screened. The employer should be aware of these. The providers should screen:

  • Employees
  • Contractors
  • Vendors
  • Medical staff
  • Volunteers
  • Referring physicians and practitioners
  • Board members
  • Anyone else working closely with the provider

There are severe consequences if someone who has faced exclusion works with or for a health program. There can be fines for up to $10,000 for each service that the party that has faced exclusion has provided. The employer can also face criminal consequences with can include being denied reinstatement to any Federal health care programs. An employer who screens employees and subcontractors every month will minimize liability.

Getting Off of the LEIE

So, many ask how do I get rid of the Exclusion list? When you find your name posted on the Medicare Exclusion List, you won’t be able to work with or for any healthcare program like Medicare or Medicaid. This list (List of Excluded Individuals/Entities or LEIE) means that you won’t be able to work for or in any of the Federal programs, and this can adversely affect your professional life as well as your personal life. It’s good to know how to get off the list and effectively get rid of the Exclusion List in your life. Experienced attorneys are at hand to assist in any appeals. A health law attorney knows all the ins and outs of getting off this list, particularly when they know health law.

The OIG Exclusion List is a list that is compiled by the Office of the IG based on different sections of the Social Security Act. After studying these sections, this office decides whether someone will face exclusion from accepting payments from Federal programs. This list itself is called List of Excluded Individuals/Entities.

Receiving a Notice of Intent to Exclude From Inspector General

After having decided that an entity or person should face exclusion from working in or for Medicare or Medicaid programs, they will send a Notice of Intent to Exclude to the individual or entity. It is only a notice of intent and does not mean that they automatically face exclusion. It gives them 30 days to then gather everything they would need in order to explain why the exclusion should not be done. All the information will be carefully studied by the OIG before making a final decision.

When you are going to be placed on the OIG Exclusion List, the IG will then send a Notice of Exclusion. When you receive it you will see an explanation of the exclusion and it will tell you how to appeal. See the date on the Notice as to when it was sent, because in 20 days from that date the exclusion will become effective. It is then time to look into finding lawyers who know health law and how to help you deal with an appeal. A health law attorney will represent you and give you the best chance of staying off this list.

You can get reinstated by going through the appeals process. The first entity you appeal to is the HHS Administrative Law Judge and ask for a hearing. He will give a decision based on the information you send with the appeal. If it is not a positive decision and in your favor, you can appeal it further to the HHS Departmental Appeals Board. Even if they don’t give a positive response, you can still move further up the ladder and go to Federal Court for a judicial review. Even though you must be proactive in getting through the appeals process, if you follow the already established procedures exactly how you are required to, you can get your name off the list.

You can always contact an attorney for legal assistance who works with a health law firm and has experience helping with this type of situation. By experience is meant an attorney who has dealt with cases like this in the past in his firm. Locating counsel to assist you through any process of appeal can mean quite a difference to your case where you need an expert health law firm.

How often do you have to check with OIG?

So, how often do you have to check the OIG exclusion list? The OIG recommends Exclusion List checks on a regular basis so entities do not in error hire those on the list. The list is constantly evolving with people added and removed continually, even daily.

The OIG’s Exclusion List is a list of individuals and entities who are not allowed to work for or with any Federal healthcare program such as Medicare or Medicaid. They are excluded for various offenses and also not being in compliance with regulations, some of which are:

  • Fraud
  • Patient abuse
  • Patient neglect
  • Program related convictions
  • License revocation

By excluding those from any Federal health care programs it means that the exclusion is from Medicare, Medicaid, health care programs funded by the United States either directly or indirectly, and any entity that provides health care benefits funded by the United States.

An employer should check the OIG Exclusion List whenever hiring or contracting someone, such as vendors or subcontractors. Then they should check each one of the employees or subcontractors against the list every month thereafter. There are thirty-seven states which have state-based exclusion lists which also should be checked.

Depending on the exclusion and the circumstance of it, some may have the ability to get reinstated and no longer be excluded. That person or entity would no longer be on the LEIE (List of Excluded Individuals/Entities). This would be discovered by an employer when checking the list.

IG Exclusion

The way a person can be reinstated is by going through an appeals process. The first appeal would be to the HHS Administrative Law Judge. From the ALJ, the individual gets a decision that is based on the information he or she provides which shows why the exclusion is not warranted.  After the ALJ completes the investigation and provides comments and a decision, if the appellant does not get a positive response, they can go further with the appeal and turn to the HHS Departmental Appeals Board. When no positive outcome there, it can be taken even further and the person can request a judicial review with the Federal Court. Following the exact requisites for these appeals can get an individual or entity removed from the exclusion list.

For those who intend to appeal and get reinstated, it is wise to contact a defense attorney to help with the appeals. Experienced attorneys care about what you are going through, and they know what sort of information needs to be presented and how to present it, thus providing a good legal representation. Hiring an attorney and having expert representation can mean the difference between being on the list and having your entire career affected, and not being on the list, so you can move forward on the path you’ve chosen.