The Office of the Inspector General (OIG) oversees and investigates allegations of fraud and abuse in the national healthcare systems, including Medicaid and Medicare. As part of their oversight, they keep track of all Medicaid and Medicare abuse cases against healthcare workers. The OIG may place any healthcare provider who was convicted for Medicare or Medicaid fraud on a “List of Excluded Individuals/Entities.” If you are on the exclusion list, you can no longer receive payments for your services from the federal government.
How do you end up on the list?
You can end up on the list if you are an individual or entity in the healthcare field, including an LPN, RN, CNA or MD. You could end up on the list for several reasons. With Permissive Exclusions, the OIG has the discretion regarding whether to put you on the list. Circumstances leading to Permissive Exclusions may include defaulting on your student loans, some misdemeanor convictions or loss of your state license.
More serious charges call for Mandatory Exclusions. The OIG has no discretion in those situations and must put you on the list for charges involving health care fraud, prescription drug offenses or patient abuse, among others.
How long will you be on the list?
The minimum amount of time you can stay on the list is one year. Under Mandatory Exclusions, you must be on the list for at least five years. There is no upper limit. Once the term of your exclusion is over, you must apply for reinstatement as a qualified health professional. The OIG does not automatically reinstate you.
You should also be aware that state Medicaid programs sometimes have their own exclusion process, in addition to the federal government. You should check the lists of any state you have worked in.
Can you still practice while on the list?
You may not bill for any services reimbursed by a federal health care program, including prescriptions. You could face fines or criminal charges. In addition, an employer who participates in government health care programs cannot hire an excluded individual. Fines for violations vary between $30,000 and $300,000. The OIG recommends employers screen their employees against the exclusion list every month.
You may feel like placement on the exclusion list is the end of your career, but it doesn’t have to be. People can and do get reinstated all the time.