Nursing is about delivering high-quality care to patients. It’s the oath we take, and the promise we keep to those entrusted to our care every day on the job. We hold ourselves to high standards, and so does the public.
As a way to preserve quality care, the Office of the Inspector General (OIG) of the U.S. Dept. of Health and Human Services (HHS) maintains a publicly available list of individuals and entities excluded from participating in all federally funded healthcare programs, like Medicare and Medicaid.
Exclusion and the ACA
Providers can be placed on the exclusion list for committing certain felonies or misdemeanors, or even for failing to pay their college loans, but more than 40 percent of those on the OIG List of Excluded Individuals/Entities (LEIE) have been placed there because their licenses have been sanctioned or revoked.
Under the Affordable Care Act, exclusion in one state applies to all states and it applies to all entities (hospitals, nursing homes, home health agencies, physician and medical groups, and insurance companies) that contract with or bill Medicare or Medicaid.
If you’re on the “Do Not Hire” list
If you are on the LEIE list, you must apply to HHS’s Office of the Inspector General for reinstatement 90 days before the end of the period specified in your exclusion notice letter. The OIG does not consider premature requests. Send a written request to: HHS, OIG, OI, Attn: Exclusions, P.O. Box 23871, Washington, D.C. 20026 and you’ll receive forms to complete. The OIG’s review can take up to 120 days, or even longer. You can reapply after one year if your reinstatement application is denied.
If you relinquish or resign your license after you know that an investigation has been opened or that disciplinary action has been taken against you, this is considered to be a “disciplinary relinquishment” and is treated as if your license had been revoked on disciplinary grounds.
The consequences are severe after discipline on your license is taken or if you resign your nursing license after receiving notice of an investigation. These include mandatory reports to all relevant bodies. And any other states or jurisdictions where you have a license will initiate its own investigation that can lead to disciplinary action.
What should you do?
Your future as a nurse is clearly at risk if your license is disciplined or revoked, or if you resign your nursing license after receiving notice of an investigation. Do not ignore an investigation in the hopes that the case will just go away on its own. Take action to defend yourself.
- If you get notice of an investigation, seek the advice right away of an attorney with experience in such professional licensing matters and administrative hearings. Do not talk to or make a written statement to any investigator until you have talked with a lawyer.
- Do not relinquish your license if you are notified that you are under investigation.
- If you are innocent of the charges, request a formal hearing and contest the charges.
- Do not request an informal hearing or a settlement agreement in which you admit the facts alleged against you are all true. Doing so is effectively pleading guilty.
- Purchase professional liability insurance that includes legal defense coverage for any professional license investigation against you, whether it is related to a malpractice claim or not.