What is an Exclusion Waiver and Who May Apply for one?

We have previously discussed that once a provider is excluded he may not furnish items or services paid for by the the Federal health care programs until he is eligible to apply for reinstatement and the Office of the Inspector General (OIG) approves this reinstatement request. The one exception to this general rule is that OIG does have the authority to grant certain excluded individuals or entities an exclusion waiver.1 

I.  What is an Exclusion Waiver?

Waivers permit certain excluded individuals or entities to be eligible for payment by Medicare, Medicaid, and all other Federal health care programs for specific items and services defined in the scope of the waiver.

A waiver will explicitly define the scope of services an excluded individual or entity may provide. It may permit payment under the Federal health care programs for covered services like office visits, home visits, and hospital visits. It may also permit hospital stays, medical tests, procedures, and/or equipment ordered by the provider, and drugs, devices, and/or other items prescribed by the provider.

II.  Who may apply?

Waivers are only available for excluded providers that are the only physician or source of an essential specialized service within a specific geographic location or institution. 

A waiver will not and cannot be granted to a person excluded due to patient neglect or abuse.

III.  How may a provider request an exclusion waiver?

A waiver may only be requested by the administrator of a Federal or state health care program.

IV.  What payment is provided under an exclusion waiver?

When a waiver is granted, payment by Medicare, Medicaid, and all other Federal health care programs is permitted for items and services that are outlined under the scope of the waiver. The waiver may limit care to a specific geographic region or to a medical specialty.

V.  What does this mean for an excluded provider?

This means that a waiver is not a viable way for an excluded provider to participate in the Federal health care programs while he waits until he is eligible to apply for reinstatement. There are currently only 18 waivers in effect. The states with the most providers practicing pursuant to an effective waiver are New Mexico (4), Montana (2), and Arkansas (2). 

VI. Conclusion

Providers are reminded that they may be excluded from participation in the Federal health care programs for employing or contracting with an excluded individual or entity. If you are excluded from participation you will likely not be eligible to participate under a waiver, and will therefore have to wait out your exclusion period to apply for reinstatement. Instead of taking these chances, contact Exclusion Screening, LLCSM today to discuss your Exclusion Screening needs at 1-800-294-0952 or fill out the form below for a free consultation.





 Ashley Hudson, exclusion waiver 

Ashley Hudson, Associate Attorney at Liles Parker, LLP and former Chief Operating Officer for Exclusion Screening, LLC, is the author of this article.


[1] Dep’t of Health and Human Servs. Office of the Inspector Gen., Waivers,  https://oig.hhs.gov/exclusions/waivers.asp (last accessed Jan. 13, 2015).

How to Apply for Reinstatement

OIG Exclusion Reinstatement

I. The OIG Exclusion 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 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 Exclusion 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 

 OIG Exclusion Reinstatement 

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.