Reinstatement of excluded individuals from Medicare Provider List

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The criteria that land a nurse on the Medi-Cal and Medicare provider exclusion list is not clear. If a nurse has broken the law and an arrest has occurred then they can find themselves on the list. Some find themselves on the list after violating the law while others, committing the exact same offense, never find themselves under that radar. It is confusing and nurses on the exclusion list feel they are being treated unfairly. If a nurse is on the list they are not being singled out by the Board. It is the nurse’s responsibility though to get themselves off the list.

Reinstatement of excluded entities and individuals is not automatic once the specified period of exclusion ends. Those wishing to again participate in the Medicare, Medicaid and all Federal health care programs must apply for reinstatement and receive authorized notice from the Office of Inspector General (OIG) that reinstatement has been granted.

To apply for reinstatement, send a written request to OIG at the address below. The OIG will then provide Statement and Authorization forms that you must complete, have notarized, and return. The information contained in these forms will be evaluated and a written notification of OIG’s final decision on reinstatement will be sent to you. Generally, this process requires up to 120 days to complete but can take longer.

Excluded providers may begin the process of reinstatement 90 days before the end of the period specified in the exclusion notice letter. Premature requests will not be considered.

If reinstatement is denied, the excluded party is eligible to reapply after 1 year.

How do I contact someone about exclusions?

Obtaining a provider number from a Medicare contractor, a State agency or a Federal health care program does not reinstate eligibility to participate in those programs. Additional information in regulations can be found at 42 CFR 1001.3001-3005.