A Quick Guide to OIG Reinstatement
Excluded healthcare professionals are banned from participating in any US healthcare program, including Medicare and Medicaid. Exclusion means individuals and entities are not allowed, either directly or indirectly, to receive payment from any of the existing US health care programs.
However, there is a silver lining to this: Exclusion is temporary. OIG Reinstatement is possible.
Reinstatement is authorized by the OIG upon the following conditions, among others:
- Exclusion period has expired.
- An assurance that there have been no recurrence or there will be no recurrence of the basis for the original exclusion.
- An additional basis for continued exclusion is nonexistent.
- All pertinent fines and penalties resulting from the basis of exclusion have been paid to Medicare, Medicaid and/or other Federal healthcare programs.
- CMS’s determination of total compliance on the part of the excluded individual/entity to pertinent conditions of participation/supplier conditions for coverage.
The reinstatement process can begin upon OIG’s determination that the excluded individual/entity has passed all the aforementioned conditions.
*It is important to note that OIG reinstatement is not automatic upon expiration of the exclusion period.
Reinstatement Process
Excluded individuals and entities must apply to the OIG for reinstatement. Reinstatement application may be submitted 90 days before the expiration of the exclusion period.
Here’s a step-by-step guide on how to go about this process.
- Send a written request to OIG using this address:
HHS, OIG, OI
Attn: Exclusions
P.O. Box 23871
Washington, DC 20026
Fax: (202) 691-2298
- Complete the Statement and Authorization forms that will be provided by the OIG.
- Have the Statement and Authorization forms notarized.
- Return the Statement and Authorization forms to the same address specified above.
- Wait for OIG’s decision. This process may take up to 120 days to complete.
- If the OIG decides to deny the request for reinstatement, excluded individuals/entities may reapply after a year.
Tips to getting reinstated
In order to make the reinstatement process as glitch-free as possible, make sure to accomplish the following:
- Complete all areas of the Statement and Authorization forms provided by OIG.
- Disclose all residency and employment details during the exclusion period.
- Verify the validity of details for cited contacts/references.
- Furnish the OIG with relevant/favorable documents such as:
- Character reference
- Employer evaluations
- Psychological/behavioral evaluations
- Educational accomplishment
- Professional references, etc.
- Seek the assistance of a healthcare attorney with expertise in reinstatement.
OIG’s proposed changes in the reinstatement process
In its effort to protect and foster the best interest of the US healthcare industry as whole, including excluded individuals/entities that are determined to make good with the US federal health care system, the OIG has recently proposed an update in its rules and regulations pertaining to reinstatement.
One such update is in terms of early reinstatement. The OIG is considering early reinstatement to be allowed for individuals who upon “fully and accurately disclosing the circumstances surrounding the original license action that formed the basis for the exclusion, the individual obtained a health care license, was allowed to retain a health care license in another State, or retained a different health care license in the same State.”
Through these efforts, the OIG seeks to give previously excluded individuals a second chance to participate in the US healthcare systems’ various programs with a renewed sense of credibility and purpose.
http://oig.hhs.gov/exclusions/reinstatement.asp
https://www.law.cornell.edu/cfr/text/42/1001.3002
http://www.thehealthlawfirm.com/blog/posts/reinstatement-after-oig-exclusion-is-not-automatic.html
For more on OIG exclusions visit our OIG Exclusion List page
