Provider Enrollment Termination and Reinstatement Services

Illinois Attorneys Helping Healthcare Providers and Pharmacists Maintain Provider Status

For those who provide healthcare services, the ability to maintain contracts with insurance companies is an essential part of doing business. Anything that threatens these contracts is likely to have a significant negative impact on a person's career. If you are facing the loss of provider status or the suspension of your professional license, The Law Offices of Joseph J. Bogdan, Inc. can help you determine your legal options and work with you to protect your practice or pharmacy.

What Is Provider Enrollment?

Provider enrollment is applicable to healthcare providers and/or entities such as pharmacies that provide healthcare services. It includes enrollment in Medicaid, Medicare, and private insurance plans. Providers can provide care to patients that are insured through insurance plans of these entities and can bill the plans for services provided to the beneficiaries. Once enrolled, providers can be terminated from the insurance plans for various reasons, such as providing substandard care, fraudulent billing, suspension or revocation of DEA registration, addictions, and non-adherence to insurance provider contract terms.

Most private insurance contracts contain provisions that allow the insurance company to terminate the provider contract if the provider's license is restricted by a state or federal agency. In many cases, after a healthcare professional's license is placed on probation or suspension, the insurance companies will send notice of an intent to terminate the contract. In addition, criminal convictions that relate to the provider's practice - particularly, convictions related to billing fraud - will also threaten a provider's ability to maintain their insurance contracts.

How Can My Provider Enrollment Be Reinstated?

The key to reinstatement with private insurers is to show rehabilitation with the Illinois Department of Financial and Professional Regulation (IDFPR). If you can show that the restrictions on your professional license have been lessened or removed and that you are legally eligible to return to normal practice, your status as a provider may be reinstated.

If you have received a notice of intent to terminate your contract with a private insurance company, if you are facing exclusion from providing care or services to Medicare and/or Medicaid patients, or if you are concerned that potential discipline to your professional license may threaten your provider status, The Law Offices of Joseph J. Bogdan, Inc. can provide the legal help you need. We help healthcare providers get back into provider status with private or public insurance plans, and we assist in the defense of professional licenses, including for those who are facing discipline by the Illinois Medical Board, the Illinois Board of Nursing, and the Illinois Board of Pharmacy. Contact our office at 630-310-1267 to set up a free consultation today.