So…you’re excluded. Your name is posted on the OIG’s List of Excluded Individuals and Entities (LEIE), and the exclusion is following you around like a scarlet letter wherever you go, preventing you from working for or with any healthcare company that bills Medicare/Medicaid. Mandatory and permissive exclusions can be enforced by the OIG for a number of reasons so it’s important to understand what you are being excluded for.
In this post, we’ll explain how to submit an application for your reinstatement.
How Long Does it Take for an Individual or Entity to Become Excluded Once Notified?
The OIG’s exclusion process is governed by regulations that implement sections of the Social Security Act. Keep in mind: “When an individual or entity receives a Notice of Intent to Exclude, it does not necessarily mean they will be excluded. The OIG will carefully consider all material provided by the person who received the Notice before making a decision.”
For both mandatory and permissive exclusions, the administrative process is the same. The OIG sends out a written Notice of Intent to Exclude which includes the reasons for exclusion and its effects. Remember, the notification is just a notice and allows the individual 30 days to gather information or evidence on whether or not the exclusion is warranted. Afterward, the OIG will make a final decision on whether or not to implement the exclusion.
If the OIG proceeds with the exclusion, a Notice of Exclusion, along with the repercussions of the exclusion and appeal rights, is sent to the individual or entity. The exclusion is effective 20 days after the Notice is mailed.
However, there is some good news. In most cases, you can be reinstated. There are steps you can take to get off the LEIE, but it requires proactive action on your part.
How to Get Off the OIG Exclusion List
IMPORTANT: Reinstatement of excluded entities and individuals is NOT an automatic process once the specified period of the exclusion ends. Most exclusions have a specific term length, often 5 years. At the end of your OIG exclusion term, you MUST apply for reinstatement and receive an authorized notice from the OIG that your request was granted. Only then will you be able to participate in all federal healthcare programs (Medicare and Medicaid).
Excluded providers may ONLY begin the process of reinstatement 90 days before the end of the excluded period. Premature requests for reinstatement will NOT be considered, so be mindful of when you can apply.
Here’s the step-by-step process to apply for reinstatement:
- Send a written request to the OIG with the following information:
- The excluded individual’s or entity’s full name (if excluded under a different name, please also include that name)
- Date of birth for an individual
- Telephone number
- Email address
- Mailing address
- Fax or email the request to:
Fax: (202) 691-2298
- Upon receiving your request, the OIG will then provide Statement and Authorization forms that you must complete, have notarized, and return. The OIG will evaluate the information and send a written notification of the OIG’s final decision on reinstatement directly to you.
This process typically requires up to 120 days to complete but can take longer.
OIG Exclusion Reinstatement Follow Up
If the OIG grants your request for reinstatement (and provides you with a notice in writing), then you’re off the list! However, it’s always good to double-check by searching the OIG LEIE. If the OIG denies your request for reinstatement, you may reapply and repeat the same process after one year.
While the process of reinstatement can be long and arduous, following the established procedures can effectively get your name off of the OIG exclusion list.