Exclusion Appeals and Reinstatement

Medicare and Medicaid Exclusion Appeals
and Reinstatement Applications

You can appeal your exclusion from Medicare and Medicaid. You can also challenge your exclusion in court and apply for reinstatement. But you must act quickly and get professional help because the process is complicated and the deadlines are short.

Exclusion from the Medicare and Medicaid programs can have devastating consequences. An individual who is excluded cannot be involved in any activity related to providing medical care, services, or supplies to recipients of Medicare and Medicaid benefits.

As a practical matter, the excluded individual cannot work for any employers that accept Medicare or Medicaid. Many private insurers also will not do business with an individual who has been excluded from Medicare or Medicaid. In many cases, exclusion forces a healthcare professional to stop practicing their profession.

If you have received a notice of exclusion or proposed agency action, then you should consult with an experienced Medicare and Medicaid exclusion attorney immediately to protect your rights and your livelihood.

Medicare and Medicaid have separate exclusion appeals and reinstatement procedures

Appealing your exclusion and applying for reinstatement are complicated because the Medicare exclusion process is different than the Medicaid exclusion process. Exclusion from Medicare is handled by the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS). Exclusion from Medicaid is handled by a state agency in each state. In New York, Medicaid exclusion is handled by the Office of Medicaid Inspector General (OMIG) at the Department of Health.

Exclusion from Medicare usually results in exclusion from Medicaid, and vice versa. But the exclusion periods do not always run concurrently. If you are not careful, you can end your exclusion by one program only to discover that the other program is just starting a new period of exclusion.

Each program has its own deadlines, rules, and procedures for appeals. The deadlines are very short; usually only 30 or 60 days. The rules and procedures are complicated. And when it comes to applying for reinstatement, you need to do it right the first time because you can only apply for reinstatement once a year.

Get an experienced exclusion lawyer on your side

When your career is at stake, you need an exclusion attorney who can guide you through the appeals and reinstatement process. Your attorney needs to understand the types of evidence and arguments that the government finds persuasive. The only lawyers who have that understanding are those who regularly represent clients in exclusion appeals and reinstatement applications.

Our lawyers have more than 30 years of experience representing healthcare professionals and providers. We have successfully represented physicians, pharmacists, nurses, nurse practitioners, physical therapists, occupational therapists, ambulance companies, durable medical equipment suppliers, and other healthcare providers in exclusion appeals and reinstatement applications. Call us today to find out how we can help you.

Consult with an Exclusion Appeals and Reinstatement Lawyer

Call (212) 601-2728

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We Are Here to Help

You are not alone. At The Howley Law Firm, we care about you. We are ready to listen to your needs and help you understand your legal rights and options.

We can help you prepare your appeal or reinstatement application and present a compelling case to the government. Most of all, we can help you protect your legal rights, your reputation, and your career.