Did you know you could be placed on the Medicare/Medicaid exclusion list—and if you are, you can’t work with any patients covered by those programs or entities that accept Medicare or Medicaid payments? If that happens, it drastically limits where you can work. Today, nearly every healthcare facility accepts Medicare or Medicaid, so exclusion could effectively shut you out of most clinical jobs. You cannot even work as a unit secretary in a place that takes these government payments.
What Is the Exclusion List?
The Office of Inspector General (OIG) is the agency that maintains and enforces the exclusion list. If you are under review, the exclusion process depends on the reason for it. There are two main categories:
- Mandatory exclusions (required by law)
- Permissive exclusions (at OIG’s discretion)
In either case, if you’re being considered for exclusion, the OIG will send a Notice of Intent to Exclude, outlining the basis for exclusion and the consequences. You then have 30 days to respond and provide documentation or mitigating information to contest it.
If the OIG moves forward, they issue a formal Notice of Exclusion, and your name is publicly listed on their website.
Why Do People Get Excluded?
Mandatory Exclusions – Minimum 5-year period:
- Medicare/Medicaid fraud or related offenses
- Patient abuse or neglect
- Felony convictions involving healthcare fraud or financial misconduct
- Criminal drug-related convictions, such as the manufacture or distribution of controlled substances
Permissive Exclusions – At OIG discretion:
- Misdemeanor healthcare fraud (not involving federal programs)
- Drug-related misdemeanors
- License suspensions, revocations, or voluntary surrenders due to professional misconduct
- Providing unnecessary or substandard care
- Defaulting on healthcare education loans or scholarship obligations
Nurses Can Be Excluded, Too
You might think exclusion only applies to doctors—but nurses and advanced practice providers are affected more often than you might expect.
You could land on the exclusion list if:
- You’re convicted of prescription fraud or any criminal offense related to Medicare/Medicaid
- You’ve been accused of withholding necessary care to federal program patients
- Your nursing license is suspended, revoked, or surrendered due to issues related to competence, integrity, or performance
Even if you didn’t know your license issue was reportable, you could end up on the exclusion list without realizing it.
How to Check the Exclusion List
It’s easy—and free—to check your status. Visit the OIG Exclusions Database here:
🔗 https://exclusions.oig.hhs.gov
If you’re listed (even unknowingly), don’t panic—but do act quickly. Review the OIG’s Special Advisory Bulletin on the effect of exclusion, and contact the HHS OIG in Washington, D.C. to learn about the reinstatement process.
Why This Matters for Employers, Too
Healthcare facilities that employ someone on the exclusion list can face major penalties—including being forced to repay money to the government and additional fines. This is why most employers routinely run exclusion checks, especially if a provider has had any disciplinary or criminal action.
Bottom Line: Protect Yourself
If you’ve had license issues, legal trouble, or disciplinary actions, take a proactive approach. Check the OIG database, and if you’re unsure about your status, talk to a healthcare attorney who can help navigate next steps.
Your career, reputation, and ability to work in most healthcare environments could depend on it.
