What Does a Healthcare Professional Do When They Are Notified By the OIG That They May Be Excluded From Medicare or Medicaid?

 Posted on January 28, 2019 in Medical License Defense

First, you should contact an attorney, one that is knowledgeable in this area. Exclusion from the Office of Inspector General (“OIG”) is a serious matter for all healthcare professionals and healthcare providing entities like hospitals or surgical centers. Exclusion by the OIG can lead to exclusion from participation in Medicare or Medicaid. OIG exclusion can be done for many reasons, ranging from a conviction related to controlled substances, fraudulent billing for healthcare services not provided, or discipline by a healthcare regulatory board. Most exclusions are mandatorily implemented by the OIG. The duration of exclusion by the OIG can vary from three to seven years or longer. This can be a serious consequence for any healthcare provider. It means that the provider or entity cannot collect payments from Medicaid or Medicare for providing services to those beneficiaries. For most practicing healthcare professionals, Medicare and Medicaid patients make up to 50% of their practice or more, depending.  

An individual or entity first gets notified by the OIG that it is considering excluding them from Medicare or Medicaid privileges. This first notification allows the individual healthcare practitioner or entity 45 days to respond to the allegations made by the OIG. The allegations are the reasons why the OIG believes the healthcare professional or entity should be excluded. If the person or entity doesn’t respond within the 45 day time, the OIG has considered that the individual or entity to have waived their right to respond. The OIG then moves forward with their case and implements the exclusion from Medicare and Medicaid billing privileges. At this point in the case, it is very difficult to have the exclusion removed.  

It is important for any healthcare professionals or entities providing healthcare services to take any notifications from the OIG seriously. Any communication received from the OIG should be reason to contact an attorney immediately. Retaining an attorney with experience in this area is crucial to increase the chances of a good outcome. Hiring an attorney with a healthcare background is also helpful in these types of cases.