Call Us Today
June 2, 2020

Healthcare Providers and the OIG Exclusion List

Millions of Dollars in Recoveries Awarded

Darren has been fortunate to be asked to represent some of the greatest clients from all over the United States against insurance companies, nursing homes, hospitals, and corporations of all sizes, including those in the Fortune 500. He has obtained numerous million-dollar plus recoveries for his clients. That is real money, not subject to appeals or reconsideration.

Martindale-Hubball recently announced Darren as a 2021 AV Preeminent Rated Attorney

The AV Preeminent Rating is the pinnacle of professional excellence earned through a strenuous peer review rating process that is managed by the law profession’s most trusted resource Martindale-Hubbell. Darren has achieved this highest peer rating standard. This rating signifies that a large number of the Darren’s peers rank him at the highest level of professional excellence for his legal knowledge, communication skills, and ethical standards.

Background

The federal Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded health care programs pursuant to section 1128 of the Social Security Act (and from Medicare and State health care programs under section 1156 of the Act) and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE).

Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties. As a consequence, to avoid liability, healthcare entities need to routinely check the LEIE to ensure that new hires and current employees are not on the excluded list.

Purpose of List

The LEIE is a tool to keep track of individuals who have been excluded from participation in federal healthcare programs due to crimes or convictions like fraud or patient neglect. But individuals who are placed on the list by the OIG don't stay there forever. Each exclusion comes with a different term, and when that term is up, individuals may apply for reinstatement (and removal from the LEIE database).
 
Reinstatement, however, doesn't occur automatically when the term ends. OIG-excluded individuals who wish to be removed from the Medicaid and Medicare exclusion list must go through a process to become employable in healthcare programs again.

How Do You Get on the List?

There are a number of ways a person can end up on the LEIE list ranging from student loan defaults to misdemeanor criminal convictions (even ones unrelated to healthcare) to out-and-out healthcare fraud, and everything in between. You can even end up on the list through a request of another federal agency.

The Problem Then Becomes, How Do You Get Yourself Off the List?

There are a number of ways a person can end up on the LEIE list ranging from student loan defaults to misdemeanor criminal convictions (even ones unrelated to healthcare) to out-and-out healthcare fraud, and everything in between. You can even end up on the list through a request of another federal agency.

Knowledge is Power

Knowing exactly when you are eligible for removal is not as easy a question as the OIG would have you believe. In the simplest of cases, it just means serving out the time of exclusion that was initially imposed. Unfortunately, it is becoming increasingly common for providers to be placed on the list without actually receiving notice. This means that you may not even know when, or for how long, you were placed on the list. It is very often the case that providers do not even know they are on the list until a prospective employer tells them they are not hireable because they are excluded.

More Roadblocks

Another serious problem is that removal from the list is often tied to the OIG getting some form of notice of eligibility from another federal agency. Which federal agency the notice comes from is not always easy to find out. Student loans are a great example of this. Unless you have settled your student loans with the Department of Justice, and notice of the settlement is sent to the OIG in a form the OIG deems sufficient (which it will not tell you), you are not eligible for removal.

The Bottom Line

The OIG exclusion list is a complicated regulatory program which requires experience and perseverance to navigate. It is highly recommended that you do not attempt to handle removal without qualified assistance. If your application is denied, even for hyper-technical reasons, you may be barred from reapplying for one full calendar year. Therefore, it is crucial that your application is complete and correct, and you are fully eligible for removal.

Conclusion

If the OIG is attempting to place you on the exclusion list, or you need help in determining if you are already on the list or in getting off the list, call Darren. He has experience with the OIG list and can help in this complex area of the law.

Recent Comments

    May 31, 2023
    The Cost of Dignity: A deep dive into the 'personal needs allowance' with THV11

    People need help as they age. We look closer at the “personal needs allowance” and how it affects those living […]

    September 10, 2021
    Does your pharmacy or medical practice receive unsolicited faxes?

    We are currently investigating a class action lawsuit under the Telephone Consumer Protection Act of 1991 (TCPA) — which limits […]

    September 2, 2021
    The Great Vacation

    As summer ends, I would like to reflect on what turned out to be a unique family vacation during a […]

    Location
    36 Rahling Circle, Suite 4
    Little Rock, Arkansas 72223
    © 2024   All Rights Reserved | The Law Offices of Darren O'Quinn
    Disclaimers: Material presented on the Law Offices of Darren O’Quinn, PLLC’s website is intended for information purposes only. It is not intended as professional advice and should not be construed as such. The material presented on this site is included with the understanding and agreement that the Law Offices of Darren O’Quinn, PLLC is not engaged in rendering legal or other professional services by posting said material. The services of a competent professional should be sought if legal or other specific expert assistance is required. Any unauthorized use of material contained herein is at the user’s own risk. Transmission of the information and material herein is not intended to create, and receipt does not constitute, an agreement to create an attorney-client relationship with the Law Offices of Darren O’Quinn, PLLC or any member thereof. This website is not intended to be advertising and the Law Offices of Darren O’Quinn, PLLC does not wish to represent anyone desiring representation based upon viewing this website in any state or jurisdiction where this website fails to comply with all laws and ethical rules. This website is not intended to constitute legal advice or the provision of legal services. By posting and/or maintaining this website and its contents, the Law Offices of Darren O’Quinn, PLLC does not intend to solicit legal business from clients located in states or jurisdictions where the Law Offices of Darren O’Quinn, PLLC or its individual attorneys are not licensed or authorized to practice law. Some links within this website may lead to other sites. The Law Offices of Darren O’Quinn, PLLC does not necessarily sponsor, endorse or otherwise approve of the materials appearing in such sites.
    crossmenuchevron-down linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram