If you sign a consent order with OPMC, will you be put on the exclusion list by Medicaid and Medicare?

Many times a physician is faced with the option of signing some type of Consent Order with the Office of Professional Medical Conduct, OPMC, to put an end to an investigation.  This is often done to avoid a possibly much worse result if the matter goes to a full blown hearing and the case is decided by a panel of three people.  You might win the hearing or you might lose it and end up with a catastrophic result, even the loss of your license.

However, be very careful as to what is said in the consent order that you sign.  Be certain that you understand the possible long term consequences.  What would happen to the economics of your practice if, shortly after you sign the consent order to get the unpleasantness of that issue behind you, you receive a letter from Medicaid and Medicare telling you that you have been placed on the Exclusion List and will not be reimbursed by them for a period of five years?  This might put you almost completely out of business and you never saw it coming.

So, what to do?  Before you sign that consent order you can send it to the New York State Office of Medicaid Inspector General and get an opinion letter. The IG will review your proposed order and tell you if they will or will not place you on the Exclusion List should you sign the order.  While this “decision” by the IG is not completely binding, I have not heard of the IG changing a position taken in this opinion letter.  The nice thing about this request is that the IG answers promptly, in about two weeks.

So, be warned, you must do everything you can to determine all of the possible consequences of signing a Consent Order.  If the IG does tell you that you will be placed on the Exclusion List, you can go back to OPMC and try to re-negotiate the terms of your consent order to avoid this very serious problem.

You need to know all of the rules if you are forced to play this game.