HHS-OIG Exclusion & CMP Defense

At Nicholson & Eastin, LLP, our team of experienced attorneys specializes in representing health care providers facing Medicare Civil Monetary Penalty (CMP) and exclusion actions by the HHS Office of Inspector General (OIG). We understand the complex regulatory landscape and can provide effective defense strategies to protect your practice and career.

Regulatory Violations

The HHS Office of Inspector General, as well as the Centers for Medicare and Medicaid Services (CMS), have the authority to impose monetary sanctions against Medicare and Medicaid providers for a wide range of regulatory violations. Our attorneys have extensive experience in defending providers against allegations including:

  • False Claims: Accusations of submitting false or fraudulent claims to Medicare or Medicaid.
  • Anti-Kickback Violations: Defending against allegations of violations of the anti-kickback statute, which prohibits the exchange of remuneration to induce referrals.
  • Stark Violations: Representation in cases involving violations of the Stark Law, which prohibits physician self-referrals for designated health services.
  • EMTALA Violations: Defending providers accused of violations of the Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals to provide emergency medical services.
  • Overpayment Refunds: Assisting providers in cases where they are alleged to have failed to timely refund overpayments received from Medicare or Medicaid.
  • Conditions of Participation and Payment: Defense against allegations of violations related to documentation, billing, and quality of care deficiencies that impact participation and payment conditions.

Consequences of CMP and Exclusion

In addition to monetary penalties, HHS-OIG has provider exclusion authority, and CMS has the authority to revoke a provider’s provider number. Both revocation and exclusion can be devastating to a provider’s practice and career and can lead to licensure action by the Department of Health, as well as the loss of hospital privileges and insurance contracts. Some violations require mandatory exclusion or revocation, others are permissive in nature. With respect to the permissive exclusion/revocation authorities, both HHS-OIG and CMS have discretion in whether to impose the sanction and for how long. These actions can have severe consequences, including:

  • Devastating Impact: Exclusion and revocation can significantly affect your practice and career, leading to potential licensure actions, loss of hospital privileges, and termination of insurance contracts.
  • Mandatory and Permissive Exclusion: Some violations require mandatory exclusion or revocation, while others are permissive in nature, granting HHS-OIG and CMS discretion in imposing the sanction and determining its duration.

Protecting Your Rights and Reputation

At Nicholson & Eastin, LLP, we prioritize safeguarding your rights and professional reputation throughout the entire process. Our attorneys work diligently to build a strong defense on your behalf, conducting thorough investigations, analyzing complex regulations, and leveraging our extensive expertise in health care law. We understand the gravity of CMP and exclusion actions and strive to minimize their impact on your practice and career. With our guidance and advocacy, you can trust that you have a dedicated legal team fighting for your best interests, advocating for fair treatment, and striving for the most favorable outcome possible. Let us stand by your side and navigate the challenging terrain of HHS-OIG exclusion and CMP defense, providing you with the peace of mind you deserve.

Consult with Our Attorneys

If you receive a notice indicating that HHS-OIG or CMS is considering imposing civil monetary penalties, exclusion, or revocation, it is crucial to seek the advice of experienced legal counsel promptly. Our team can provide expert guidance and develop a robust defense strategy tailored to your specific case. Contact Nicholson & Eastin, LLP today to schedule a consultation and protect your rights and professional reputation in the face of CMP and exclusion actions.


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