The United States Department of Health and Human Services (HHS) is a cabinet level department underneath the President of the United States. HHS has a plethora of duties and functions. HHS is responsible for maintaining the Medicare Exclusion List. The Medicare Exclusion List is comprised of individuals that are barred from the Medicare Program. The HHS Medicare Exclusion List is also distributed to all local and state authorities that administer Medicare and Medicaid programs. Many individuals, healthcare providers and non healthcare providers alike, are surprised at their inclusion on the Medicare Exclusion List.
Attorneys for the United States Department of Health and Human Services will notify a Respondent in writing of a proposed inclusion on the Medicare Exclusion List. The Respondent will have the opportunity to present written argument as to the why inclusion on the Medicare Exclusion List is not warranted. If the decision s unfavorable to the Respondent, the Respondent can request a Hearing before an HHS Administrative Law Judge. HHS Administrative Law Hearings regarding the Medicare Exclusion List are held throughout the United States. Further Appeals can be made through the HHS Administrative Law process and ultimately to Federal Court.
The most common reason that a healthcare practitioner receives a notification of inclusion on the Medicare Exclusion List is due to a criminal conviction. Felony criminal convictions involving alcohol, drugs or theft almost always result in inclusion on the list. Misdemeanor criminal convictions may also result in inclusion on the Medicare Exclusion List. Other reasons for inclusion on the Medicare Exclusion List include discipline from state level Administrative Law Professional Licensing agencies. Doctors, Nurses, Pharmacists, Dentists and other healthcare professionals who receive state Administrative law discipline can also be subject to inclusion on the HHS Medicare Inclusion List.
Most HHS Medicare Exclusions have a set exclusionary period. However, an individual must petition to remove himself or herself from the HHS Medicare Exclusion List. Petitions must be made in writing. An unsuccessful reinstatement petition requires a one year waiting period until submitting a new petition for Medicare Exclusion List renewal.
More and more healthcare providers such as Doctors, Dentists, Nurses and Pharmacists are relying on Medicare patients. Thus, it is important to avoid inclusion on the HHS Medicare Exclusion List.