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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