Reinstatement of an excluded individual or entity is not automatic once the specified period of exclusion ends. In order to participate in the Medicare, Medicaid, and all federal healthcare programs once the term of exclusion ends, the individual or entity must apply for reinstatement and receive written notice from OIG that reinstatement has been granted.
An individual or entity with a defined period of exclusion (e.g., 5 years, 10 years, etc.) may begin the process of reinstatement 90 days before the end of the period specified in the exclusion notice letter. Requests received earlier than 90 days before the end of the period of exclusion will not be considered.
An individual or entity excluded under section 1128(b)(4) of the Social Security Act, whose period of exclusion is indefinite, may apply for reinstatement when they have regained the license referenced in the exclusion notice. However, under some conditions an individual or entity excluded under section 1128(b)(4) may apply for early reinstatement without regaining the license referenced in the exclusion notice if they have obtained (1) a different healthcare license in the same state or (2) any healthcare license in a different state. In addition, reinstatement may be available if the individual excluded under section 1128(b)(4) does not have a valid healthcare license of any kind in any state and has been excluded for a minimum period of 3 years, following the OIG’s consideration of all the factors specified in the regulations. This process for early reinstatement is not available to an individual excluded under section 1128(b)(4) if the individual’s license was revoked, suspended, or otherwise lost or surrendered for reasons relating to patient abuse or neglect.
Obtaining a provider number from a Medicare contractor, a state healthcare program or a federal healthcare program does not reinstate an individual’s or entity’s eligibility to participate in those programs.
To apply for reinstatement, an excluded individual or entity must send a written request which contains the 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, and mailing address.āÆTheāÆrequest can be faxed ((202) 691-2298) or emailed (exclusions@oig.hhs.gov) to the OIG.āÆ
Issue:
The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud. Those that are excluded can receive no payment from federal healthcare programs for any items or services they furnish, order, or prescribe. OIG maintains a list of all currently excluded individuals and entities called theāÆList of Excluded Individuals/EntitiesāÆ(LEIE). Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). To avoid CMP liability, healthcare entities should routinely check the list to ensure that new hires and current employees are not on it.
Discussion Points:
- Review your policies and procedures for screening of potential employees to confirm that they are not included on the OIG Exclusion List. In addition, review your policies and procedures for frequency of checking the OIG Exclusion List for all current employees and vendors. Update policies as necessary.Ā
- Train all appropriate staff on the requirement for checking the OIG LEIE link for all new potential hires, current employees, and vendors, and the frequency for repeating the checks. Document that the trainings occurred and file the signed document in each employeeās education file.Ā
- Periodically audit to ensure that all new employees have been confirmed as not being on the OIG LEIE. Also, determine that routine checks are being conducted for current employees to ensure that they have not been added to the OIG Exclusion List in the period since the last LEIE check. Ensure that a copy of the OIG LEIE screening confirmation is included in each employee or vendor file.Ā
