Illinois Office of Inspector General Defense Attorney

Lawyer Helping Doctors Under OIG Investigation Protect Their Provider Status in Illinois

Many doctors and health care professionals in Illinois and throughout the United States rely on federal funding secured through their status as Medicare and Medicaid providers. However, in order to maintain this provider status, it is important to remain in good standing with the Office of Inspector General (OIG) in the U.S. Department of Health & Human Services. If you are under investigation by the federal OIG or one of its state affiliates, you may be at risk of losing your provider status and the funding that comes with it.

Attempting to handle an OIG investigation on your own can be costly, especially if you are unfamiliar with the process. However, with The Law Offices of Joseph J. Bogdan, Inc. on your side, you can benefit from the guidance and representation of an experienced attorney to help you protect your rights and your medical career. We strive to prevent you from facing exclusion from federal funding, or to help you get your funding reinstated if you have been excluded.

What Does the OIG Investigate?

The Office of Inspector General provides oversight for federally funded health care programs, primarily including Medicare and Medicaid. The federal OIG typically focuses on investigations of Medicare providers, while state OIG offices conduct investigations of providers of Medicaid, which is administered at the state level with the assistance of federal funding. Federal and state OIG investigations both typically look for evidence of fraud, abuse, and other forms of misconduct among providers. Common reasons that the OIG may take action against a health care provider include:

• Fraudulent billing for Medicare or Medicaid services
• Criminal convictions for health care fraud or financial misconduct
• Criminal convictions related to controlled substances, including for illegal manufacturing, distributing, or prescribing
• Abuse or neglect of patients
• Substandard care or services
• Suspension or revocation of a medical license due to professional competence or performance
• Illegal kickbacks
• Health care education loan defaults

Severe offenses like felony convictions and Medicare or Medicaid fraud require mandatory action on the part of the OIG, while in the case of lesser offenses, the OIG has the discretion to take action or not depending on the circumstances.

Potential Consequences of OIG Investigation

If the OIG finds that you have committed a punishable offense, you can be excluded from the Medicare and Medicaid programs, which comes with a variety of consequences. First and foremost, an exclusion means that you will lose federal funding, usually for a defined time period of three, five, or ten years. A loss of this nature can mean substantial professional and personal financial hardship, and it may prevent you from being able to maintain your practice.

In addition to the loss of funding, you will also be placed on the List of Excluded Individuals/Entities (LEIE) for the duration of the exclusion. This list is publicly searchable, meaning that your presence on it can harm your reputation among patients and peers. Furthermore, anyone who hires a provider that is on the LEIE can face monetary penalties, so exclusion can severely limit your employment and career opportunities.

Responding to OIG Exclusion

Because OIG inclusions are often connected to other professional consequences, it is important to work with an attorney who can advise and defend you when you are under any type of criminal or administrative investigation that could impact your medical career. Strong legal representation could help you avoid a situation that could justify OIG exclusion in the first place.

If you are facing imminent OIG exclusion, you will typically receive a written Notice of Intent to Exclude (NOI), and you will have the opportunity to work with your attorney to prepare a response that may help you prevent the exclusion. Usually, the OIG allows for a response in writing supported by evidence of mitigating circumstances or anything else that may demonstrate that you have not committed an act meriting exclusion. In some cases, you may also be able to request an opportunity to present an oral argument in your defense.

If the OIG decides that exclusion is warranted, your attorney may be able to help you appeal the decision to an Administrative Law Judge, the Health and Human Services Departmental Appeals Board, or a federal court. If the decision stands, your attorney can help you apply for reinstatement of your provider status after the exclusion period has ended, allowing you to be removed from the LEIE and once again benefit from federal funding.

Contact an Illinois OIG Exclusion Defense Lawyer

If you need a lawyer to fight an OIG exclusion or to seek reinstatement, Attorney Joseph Bogdan can help. We serve doctors and health care providers in DuPage County, the Chicago area, and the State of Illinois, and we can get started on your case with a free initial consultation when you contact us at 630-310-1267.