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.
How Does an Individual or Entity Become Excluded?
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. Then and only then will the OIG make a final decision on whether or not to grant the exclusion.
If OIG decides to proceed with the exclusion a Notice of Exclusion, along with the repercussions of the exclusion and appeal rights, is sent to the individual. The exclusion is effective 20 days after the Notice is mailed.
But there is some good news…in most cases, you can be reinstated. There are ways to get off the list, but it does require 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 an 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 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 of applying for reinstatement:
1. To apply for reinstatement, send a written request to the OIG at the address below:
Washington, D.C. 20026
2. Upon receiving your written request, the OIG will then provide Statement and Authorization forms that you must complete, have notarized, and return.
3. The OIG will evaluate the information on these forms and will 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 (and has).
OIG Exclusion Process Follow Up
If the OIG grants your written 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 OIG denies your written request for reinstatement, you may reapply and redo the whole process after one year.
While the process of reinstatement can be long and arduous, following the established procedures in order (and at the right point in time) can effectively get your name off of the OIG exclusion list.
Simply follow directions, fill out the forms in their entirety, and don’t apply before 90 days prior to the end of your excluded term, and you should be ok.
We hope this information has been helpful but the truth is, life can be complicated, right? There are many different scenarios or situations that one can find themselves in that require extra attention or Please let us know how we can be of any assistance with understanding the OIG exclusion process better.