How Can I Appeal a Medicare Exclusion Decision?
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.
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.
How Can I Apply for Medicare Reinstatement?
Medicare reinstatement is not automatic. If you have been 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.