How Might I Get on the Exclusion List for Medicare/Medicaid?

Say, for instance, that you are charged with an incident of medical misconduct by the New York State Department of Health’s Office of Professional Medical Conduct (OPMC). Then, say that the OPMC sends you a Consent Order to stop your illegal conduct without further pursuing an investigation. This may seem like an excellent deal, but there may be hidden stipulations. That is, you may be placed on Medicare’s or Medicaid’s exclusion list. Read on to discover how you might get on the exclusion list for Medicare or Medicaid and how one of the seasoned HMO/Medicare/Medicaid audit protection lawyers at Walker Medical Law can help you out of this situation.

How might I land on the exclusion list for Medicare or Medicaid?

You may be eager to sign off on a Consent Order so that you can place an immediate stop on the OPMC’s investigation against you. What’s more, you can almost seamlessly avoid any long-term consequences that may come with an ultimate OPMC hearing, such as the permanent revocation of your medical license.

However, you must carefully comb through the terms and conditions that are within this Consent Order. For one, there may be a disclosure within this order that allows Medicare or Medicaid to place you on their exclusion list. This is because federally-funded healthcare programs are allowed to exclude both medical professionals and medical practices from their benefits if they are convicted of medical misconduct. This is especially the case if the medical misconduct in question is Medicare or Medicaid fraud.

This means that you may not be reimbursed by them for five years. Further, you may be excluded from payment for any items or services that you have furnished, ordered, or prescribed. Overall, this may have a great economic consequence on your medical practice, to the point that it may take you out of business.

What’s more, all medical professionals and medical practices that have been excluded may be placed on the List of Excluded Individuals/Entities. This may negatively impact your professional career, as any party who hires an individual or entity on this list may be subject to civil monetary penalties.

How can I avoid this repercussion?

At the end of the day, you must not jump on signing a Consent Order without thoroughly considering its potential repercussions. Instead, it may be in your best interest to send the Consent Order to the New York State Office of Medicaid Inspector General. For here, the inspector general may review your proposed order and determine whether it will place you on Medicare’s or Medicaid’s exclusion list. It is worth mentioning that this is simply an opinion letter by the inspector general, meaning their word is not binding. Nonetheless, you may receive this opinion letter within two weeks.

There is no time like the present when defending your medical license. So reach out to one of the competent HMO/Medicare/Medicaid audit protection lawyers from Walker Medical Law today.