I. The OIG Reinstatement Process
Most exclusions are imposed for a definite time period. The question for an excluded individual or entity is: What happens at the end of the exclusion period? The answer is that the excluded individual or entity MUST apply for OIG reinstatement. The U.S. Department of Health and Human Services (HHS) will NOT automatically reinstate the person or entity at the end of the exclusion period. An excluded provider may apply for reinstatement 90 days before the date specified on his, her, or its exclusion notice letter. To apply for reinstatement the excluded individual or entity must send a written request to:
HHS, OIG, OI
Attn: Exclusions
P.O. Box 23871
Washington, DC 20026
(202) 691-2298 (Fax)
The Office of the Inspector General (OIG) will send the provider Statement and Authorization forms to complete, notarize, and return. OIG will review these forms and will send the provider a written notification of its final decision. This process may take 120 days or longer to complete.
II. Denial of OIG Reinstatement
If the application for reinstatement is denied, the excluded individual or entity may submit evidence and a written argument against the continued exclusion; a written request to present written evidence and oral argument to an OIG official; or documentary evidence and a written request to present oral argument.[1] The evidence, written argument, or written request for a hearing must be submitted 30 days after the provider receives the written notice of OIG’s final decision.[2]
After reviewing the materials (or after the 30-day period, if no materials are submitted), OIG will send the provider written notice either confirming the denial or approving the request for reinstatement.[3] If OIG confirms its decision to deny reinstatement, the decision will not be subject to administrative or judicial review and the provider must wait at least one year to submit another request for reinstatement.[4]
Read more on OIG Exclusion
Ashley Hudson, Associate Attorney at Liles Parker, LLP and former Chief Operating Officer for Exclusion Screening, LLC, is the author of this article. Feel free to contact us at 1-800-294-0952 or online for a free consultation.
[1] 42 C.F.R. 1001.3004 (2014).
[2] 42 C.F.R. 1001.3004.
[3] 42 C.F.R. 1001.3004.
[4] 42 C.F.R. 1001.3004.
Frequently Asked Questions
Reinstatement
If a Provider is Reinstated by the OIG, are they automatically Readmitted to Medicare?
Unfortunately, the answer to this question is also “No.” Providers that have been reinstated and removed from the LEIE must still reapply for Medicare billing privileges to the Center for Medicare and Medicaid Services. Although CMS and OIG are part of the same agency (Health and Human Services), the actions of one do not bind the other, and CMS will often maintain a revocation after reinstatement.
What happens at the end of the exclusion period?
The answer is that the excluded individual or entity must apply for reinstatement. HHS will NOT automatically reinstate the person or entity at the end of the exclusion period.
An excluded provider may apply for reinstatement 90 days before the date specified on his, her, or its exclusion notice letter. To apply for reinstatement the excluded individual or entity must send a written request to:
HHS, OIG, OI
Attn: Exclusions
P.O. Box 23871
Washington, DC 20026
(202) 691-2298 (Fax)
Participating providers with private payers are also likely to be required to screen the LEIE regardless of whether or not they accept federal funds! Most participation agreements with private payers include contractual clauses that specifically exclude reimbursement for items or services provided by excluded parties.
What is a Waiver?
When the Office of the Inspector General (OIG) grants an excluded individual or entity a waiver it permits payment by all Federal health care programs for certain items and services defined in the scope of the waiver.
A waiver permits payment under the Federal health care programs for: covered services like office visits, home visits, and hospital visits; hospital stays, medical tests, procedures, and/or equipment ordered by the physician or other health care provider, and drugs, devices, and/or other items prescribed by the health care provider.
For more information about waivers, visit What is an Exclusion Waiver and Who May Apply for one?