Tuesday, October 9, 2007

Medicare/Medicaid Exclusion

You decided that you can't fight the Nursing Board any longer or something has come up that affects your ability to fight the Nursing Board, so you decide to voluntarily surrender your nursing license or perhaps the Board suspends or revokes your license, so you decide that you will work as a nurse's aide or maybe a tech in a hospital or clinic. However, if the cause of the suspension or revocation is one designated by the Social Security Act as a practice violation that merits action, you may find yourself unable to even work as an aide or tech.

The specific law is: Pursuant to section 1128(b)(4) of the Social Security Act, the Office of the Inspector General may exclude an individual or entity-

(A) whose license to provide health care has been revoked or suspended by any State licensing authority, or who otherwise lost such a license or the right to apply for or renew such a license, for reasons bearing on the individual's or entity's professional competence, professional performance, or financial integrity, or

(B) who surrendered such a license while a formal disciplinary proceeding was pending before such an authority and the proceeding concerned the individual's or entity's professional competence, professional performance, or financial integrity.

Pursuant to section 1128(c)(3)(E) of the Act, the length of an exclusion under section 1128(b)(4) -

shall not be less than the period during which the individual's or entity's license to provide health care is revoked, suspended, or surrendered, or the individual or entity is excluded or suspended from a Federal or State health care program.

So, what this means is that you are not allowed to work for any entity, no matter what your role, that receives Medicare/Medicaid funding. Also, when the exclusion period is over, you have to make a formal request to be removed from the excluded list; your name is not automatically removed when the time is up. There are many more caveats to this law, but this is just a quick glance in order to warn nurses that may be looking at voluntary surrender.

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