Very devastating. If your healthcare practice (general physician, dentistry, pain management clinic, ophthalmology) is notified of its Medicare exclusion, you must cease billing all federally funded health programs. That can cause:
You can be excluded from Medicare for a variety of reasons outlined in 42 U.S.C. §1320a-7.
Some felony convictions can result in Medicare exclusion, especially those arising from healthcare fraud or the unlawful manufacture, distribution or prescription or dispensing controlled substances (drug trafficking).
You also can be excluded from Medicare for a misdemeanor conviction related to obstruction of an investigation or controlled substances.
State professional license suspension also can result in Medicare exclusion. Additionally, any individual who has engaged in fraud, kickbacks and/or self-referral violations (Anti-Kickback and Stark Law/self-referral) can be excluded — even if it does not result in a conviction.
You have only 60 days from your notice of Medicare exclusion to appeal the HHS OIG decision. Given that Medicare exclusion can be career ending, you should appeal your Medicare exclusion by requesting a hearing before an Administrative Law Judge as soon as possible.
As with reinstatement, you essentially have one shot at an appeal, and you should consider hiring a Medicare exclusion reinstatement attorney to appeal the Medicare exclusion decision. Pursuant to 42 CFR 402.214, you must request a hearing within 60 days from the receipt of the notice of exclusion. The request for a Medicare exclusion hearing should be completed by an experienced health law attorney and must include:
If you do not file a timely request for a hearing, you may lose your right to appeal. Therefore, it is imperative that you file your request for a Medicare exclusion hearing within 60 days and ensure that it contains all the necessary information. Failure to properly petition for a Medicare exclusion hearing will result in loss of your right to appeal.
If you are granted a hearing, your attorney will be able to present arguments to an Administrative Law Judge and seek reinstatement.
If the Medicare exclusion was in error, you will be reinstated.
Medicare reinstatement is not automatic. If you are notified of exclusion from Medicare by the OIG, you must understand that you are prevented from working for any individual or entity that contracts with Medicare, TriCare or other federally funded programs until you receive notice of reinstatement.
If a health care provider is excluded from Medicare, he/she can reapply within 90 days of the expiration of the Medicare exclusion. It can take up to six months or more for the OIG to rule on your Medicare reinstatement application.
To apply for Medicare reinstatement, you must send a written request to the OIG and provide a statement with the relevant authorization forms. The information in your statement and forms will be evaluated, and the OIG will send you written notification of its decision, which could take up to 120 days or longer.
If the OIG denies your Medicare reinstatement application, you will not be able to apply for Medicare reinstatement for one calendar year.
Our Medicare exclusion lawyers at Chapman Law Group defend health care providers nationwide during Medicare exclusion and Medicare reinstatement proceedings. With strong experience in health care compliance strategies and Medicare audit process representation, we can guide you through every step to ensure that you have the best possible chance at reinstatement. We know what information the OIG will want to see in your statement, thus improving your chances of a favorable Medicare reinstatement decision.
With four national healthcare law office locations to serve you, our health care compliance lawyers will provide the advice and expertise your practice needs.
Chapman Law Group has four national compliance practice offices: Detroit, Michigan; Miami and Sarasota, Florida; and Los Angeles/Southern California. Contact us today.
"*" indicates required fields
Our attorneys argued to the OIG that exclusion for the prescribed time period was unreasonable under OIG regulations, and that most factors that would lead to a greater exclusion period were inapplicable.
Our attorneys worked with the DEA and negotiated by offering a compliance program to bring the physician back into compliance with the DEA’s requirements.
Can Medicare/Medicaid/government contractors seek debts after a bankruptcy filing? Yes, but it can be complex, and methods vary by jurisdiction.
If a physician is excluded from Medicare/Medicaid because he/she accepted a kickback, does this mean he/she could be denied DEA registration in the future? Not necessarily.
As the federal government is casting a wider net to detect and prosecute fraud in the medical industry, the question is not if your medical
For Medicare fraud defense, your health care practice should rely on an attorney with detailed-specialized knowledge of everchanging rules and regulations.
Michigan OFFICE
1441 W Long Lake Road
Suite 310
Troy, MI 48098
T. 248.644.6326
F. 248.644.6324
CALIFORNIA OFFICE
5250 Lankershim Blvd.
Ste. 500
North Hollywood, CA 91601
T. (818) 287-0576
FLORIDA OFFICES
6841 Energy Court
Suite 120
Sarasota, FL 34240
T. 941.893.3449
701 Waterford Way
Suite 340
Miami, FL 33126
T. 305.712.7177
Practice Areas
Attorneys
© CHAPMAN LAW GROUP. ALL RIGHTS RESERVED
