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LawHelpNow, Attorney/Lawyer
Category: Criminal Law
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medicare exclusion

Customer Question

in 1999 my company was excluded from medicare. the government then permanently excluded me. i had a company that did all my billing on a percentage basis. i have been fighting this for all this time. now my attorney says its not likely to happen because it would set a precedent. is there any hope? i'm a registered nurse and just want to work in my field.
Submitted: 8 years ago.
Category: Criminal Law
Expert:  LawHelpNow replied 8 years ago.

Hello and thanks so much for choosing this forum to pose your important legal question. I will do my best to give you some honest and accurate guidance as I answer your question.


  1. I am a licensed attorney, and I will be glad to try and answer your question. I hope that the following information will be helpful to you, but please just write back if you have any follow-up questions or need clarification on anything after reviewing the following information. I am sorry for what has happened to you, and I hope that things gets resolved appropriately.
  2. Unfortunately, I am afraid that I do not have terribly encouraging news to share. Just for a bit of background, I am also a registered nurse and have practiced this type of administrative law. The U.S. Department of Health & Human Services Office of Inspector General exclusions list is simply a nightmare for many professionals in situations similar to yours. This is due, in large part, to it being a matter of administrative law. In other words, rather than the "beyond a reasonable doubt" standard (criminal law) or even the "by a preponderance of the evidence standard" (civil), in this case we are dealing with the "substantial evidence rule" (administrative law). Despite its name, all that is required to be "substantial" is that there be more than a mere scintilla (or speck) of evidence. In your case, the fact that action was taken against your license (or that of your former business) is enough. The federal government simply works off of that basis without performing its own independent investigation into the underlying specifics of your case.
  3. Given that it has been 10 years, you would certainly meet the five year exclusion requirement under the most common basis for exclusion -- namely § 1128(a)(1) of the Social Security Act, 42 USC § 1320a-7(a)(1). There are numerous exclusion authorities relied upon by the federal government, but I was just making an assumption based on what you have related and my years of professional experience. If the requisite amount of time has passed, then it looks like you have already unsuccessfully completed the application process and appeal. Your mention of having a lawyer and the agencies you listed leads me to that conclusion. I am sorry to say that your only remaining option would be to file suit in federal court. This would be very much an uphill battle requiring skilled representation by a member of the federal bar. Other than being able to go back and attack the underlying action that originally led to being listed on the exclusion list (i.e. successfully overturning a conviction), I am afraid this is how things stand. I am truly sorry if I sounded harsh or discouraging, but I mainly want to be upfront with you and not pull any punches. Some health professionals, provided their state license is active and unrestricted, have found employment in fields such as elective cosmetic surgery where governmental funds are not accepted. Given that Medicare exclusions almost always leads to reciprocal Medicaid exclusion, this obviously makes opportunities in the health care field severely limited.


I hope that this information has been helpful to you. If we can be of any further assistance please free to use our service again. Best wishes for a successful outcome.

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The information provided is general in nature only and should not be construed as legal advice. By using this forum, you acknowledge that no attorney-client relationship has been created between you and Benjamin M. Burt, Jr., Esq. You should always consult with a lawyer in your state.

LawHelpNow and 2 other Criminal Law Specialists are ready to help you
Customer: replied 8 years ago.
could i work at the veterans' administration hospital
Expert:  LawHelpNow replied 8 years ago.

Hello again and thanks for writing back. I will be glad to comment further.


I am very sorry to say the answer is no. I have research probably every possible route (travel agencies, veterans' administration) -- you name it. The botXXXXX XXXXXne is the VA will not employ folks listed on the exclusion list. Even working in a different capacity will not suffice -- i.e. a nurse working as a clerk. It even goes so far as to prohibit one from even contracting with a facility -- i.e. providing lawn care services to a hospital. I truly wish things looked brighter.


Take care and thanks again for using JustAnswer®.