When you find your name posted on the OIG Exclusion List, you won’t be able to work with or for any health care program like a Medicare or Medicaid provider. 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. An employer will regularly screen the names on the list to ensure he or she has not hired someone whose name is on it. It’s good to know how to get off the list and effectively get rid of the OIG Exclusion List in your life. You want to avoid having your name on this whenever possible.
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Excluded From Federal Inspector General List
The OIG Exclusion List is a list that is compiled by the Office of the Inspector General based on different sections of the Social Security Act. After studying these sections, this office decides whether they will exclude someone from providing services with Federal programs. This list itself is called List of Excluded Individuals/Entities. Employers check this list often to verify whether or not a potential hire or an employee is on it.
Receiving a Notice of Intent to Exclude After Screening
After having decided that an entity or person should be excluded from working in or for Medicare or Medicaid providers and services, 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 are automatically excluded. 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 List, the OIG 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.
You can get reinstated by going through the appeals process. The first entity you appeal to is the HHS Administrative Law Judge. This department 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 this department doesn’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 with experience helping with this type of situation. An attorney can assist you through any process of appeal and you should take advantage of his services.
What does it mean to be on the OIG exclusion?
So, what does it mean to be on the OIG exclusion list? It’s important to know what the OIG Exclusionary 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 Federal human health care programs. This list is called the LEIE or List of Excluded Individuals/Entities. The public, patients and everyone in the health industry can thereby stay informed.
The Notice of Intent to Exclude (Federal not State)
The OIG takes into consideration sections of the Social Security Act in order to determine whether or not they will exclude someone from the Federal programs. When they decide to exclude an individual or entity, they will send them a Notice of Intent to Exclude. This doesn’t mean they are excluded. 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 list, it means that you won’t be able to participate in Federal health 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 the 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.
If an individual was excluded under section 1156 of the Social Security Act, he or she can request a hearing if Federal program human 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. 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. The best way to keep out of trouble here is to hire an attorney to represent you, one that knows the related law.
How often do you have to check the Department?
So, how often do you have to check the OIG exclusion list? The OIG recommends exclusion screening 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 health care program such as Medicare or Medicaid. They are excluded for various reasons some of which are:
- Patient abuse
- Patient neglect
- Program related convictions
- License revocation
- Pharmacy fraudulent acts
By excluding those from any Federal health care programs it means that the exclusion is from Medicare, Medicaid, and health care programs funded by the United States either directly or indirectly, and any entity that provides health benefits funded by the United States.
An employer should check the 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 hosted by a state’s Medicaid program which also should be checked. All state lists 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.
OIG Appeal Process
The way a person can be reinstated and accomplish a removal from the list is by going through an appeals process. The first appeal for reinstatement would be to the HHS Administrative Law Judge. From him the individual gets a decision that is based on the information he or she provides which shows why the exclusion is not warranted. If the person does not get a positive response, he 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 an experienced attorney in a law firm to help with the appeals. This is the best way to get exclusion from screening and provide you with the defense you need. He knows what sort of information needs to be presented and how to present it. Hiring an attorney who knows health law 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.