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Nurses Hit Hardest by Medicare and Medicaid Exclusions

Posted in Fraud and Abuse, Medicare and Medicaid, White Collar

A July 19 article in Bloomberg BNA’s Health Care Fraud Report and other publications, “Nurses Hit Hardest by Medicare and Medicaid Exclusions,” discussed the exclusion of nurses and physicians from participation in the Medicare and Medicaid programs. The article pointed out that 30,123 nurses were excluded as of 2016, compared to 1,588 physicians, although there are only 3-4 times as many licensed nurses in the U.S. compared to licensed physicians.  

Day Pitney’s Eric Fader was quoted in the article. Eric told Bloomberg BNA that the disparity in the numbers of exclusions, which prevent individuals or entities from being paid by Medicare, Medicaid, or any other federal healthcare program, may be due in part to different approaches to seeking reinstatement at the end of the mandatory exclusion period. “Perhaps some percentage of nurses and other lower-level health-care providers who are excluded get jobs doing other things, either in health care or in unrelated fields, during their exclusion period and then never bother applying for reinstatement,” Eric said.

In contrast, Eric added, a physician who is excluded would almost certainly apply for reinstatement at the earliest possible moment, because the ability to provide services to Medicare and Medicaid patients is critical for physicians. Also, an individual who is a physician would be less likely to switch to another career during the exclusion period – both because he or she has more invested in his career, and because an alternative career would be less likely to have similar earning potential.

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