Exclusion from the Medicare program has a devastating impact on your career. Once you receive notice that you have been excluded from Medicare, you must stop billing all federally funded health care programs. You need to address this situation immediately to protect your rights, your livelihood, and your professional license.
Exclusion from Medicare will affect your ability to practice your profession. It could also end your career. In addition to losing your ability to bill Medicare,
Grounds for Medicare Exclusion
The most common reason for Medicare exclusion is a criminal conviction. The Medicare program is required to exclude you if you are convicted of certain felonies such as those involving health care fraud or violations of controlled substances laws. You may also be excluded from the Medicare program based on a misdemeanor conviction, a suspension of your professional license, exclusion from a State Medicaid program, or participation in healthcare fraud, kickbacks, or Stark law violations even if you were never convicted of a crime.
Strict Deadlines for Medicare Exclusion Appeals
The deadline to challenge Medicare exclusion is short and strictly enforced. If you are excluded by the Office of Inspector General (OIG) at the Department of Health and Human Services (HHS), then you have only sixty (60) days from the date of your exclusion notice to appeal. In some states, you only have thirty (30) days to appeal a notice of exclusion from the Medicaid program.
It is critical that you get an experienced Medicare exclusion appeals lawyer on your side immediately. Your appeal will be dismissed without review if you miss a filing deadline. Moreover, your lawyer will need time to develop your arguments and evidence for a successful appeal.
Appealing a Medicare Exclusion Decision
You have only one chance to appeal your exclusion from Medicare, and that appeal must be filed within 60 days of your notice of exclusion.
Your appeal begins with a request for a hearing before an administrative law judge (ALJ). The ALJ is permitted to decide only two issues: (a) whether there is a legitimate basis for the exclusion; and (b) whether the duration of the exclusion is unreasonable.
The request for a hearing must describe the specific issues or findings of fact and conclusions of law in the notice of exclusion that you challenge, the basis for your challenge, the defenses that you intend to assert, why the proposed length of exclusion should be modified, and why the health or safety of Medicare beneficiaries does not warrant exclusion from the Medicare program.
Given that your career is at stake, an exclusion appeal is too important to handle on your own. You need an experienced exclusion appeals advocate who can help you develop the evidence and present it in a cohesive, compelling argument.
Applying for Medicare Reinstatement After Exclusion
Medicare reinstatement after exclusion is not automatic. You must file an application for reinstatement to the Medicare program.
You are allowed to file your application for reinstatement within ninety (90) days of the expiration of the Medicare exclusion. Your application for reinstatement must include a written request and a statement of the reasons for reinstatement with the relevant authorization forms.
OIG will review your application for reinstatement and send you a written notification of its decision. If OIG denies your application for reinstatement to the Medicare program, then you must wait a full year before submitting another reinstatement application,
OIG’s decision could take up to six months, so it is critical that you file your application for reinstatement as soon as you are allowed to do so.
Finding an Experienced Medicare Exclusion Attorney
When your career is at stake, you need an experienced exclusion attorney who can guide you through the appeals and reinstatement process step-by-step. Your attorney needs to be familiar the type of information OIG finds persuasive in order to improve your chances of success.
John Howley, Esq. has more than 25 years of experience representing health care professionals and providers. He has successfully represented physicians, pharmacists, nurses, nurse practitioners, physical therapists, occupational therapists, ambulance companies, durable medical equipment suppliers, and other healthcare providers in exclusion appeals.
To schedule a consultation with Mr. Howley, call him directly at (212) 601-2728.