Many consequences can happen to a physician who has faced the disease of addiction. One of the worst is to be placed on the Office of the Inspector General (OIG) exclusion list, which prohibits billing for both Medicare and Medicaid. During my hydrocodone addiction, I diverted the medication by writing prescriptions to my patients, who would bring the pills back to me for my use. I was charged with a felony, pleaded guilty after two years of wasted time in negotiations, and was placed on four years of probation. After two years, my probation was ended thanks to my probation officer advocating for me to the judge. Thirteen months after I had pleaded guilty, I received a bombshell letter in the regular mail from the OIG informing me I was placed on the exclusion list for five years because of my felony conviction. This came nine months after I had been fully credentialed for both Medicare and Medicaid with full disclosure of my felony and history of drug addiction and nearly five years since I last diverted a narcotic. I was practicing family medicine in a small town in North Carolina at the time, and I maintain medical licenses in both North Carolina and Nebraska that have been rendered worthless.
There are several ways to respond when placed on the OIG exclusion list. An appeal can be filed within 60 days of receipt of the letter. I was informed by my attorney and the hospital administration not to file an appeal because they were going to seek a waiver of the exclusion since I was practicing in an underserved area. I was instructed to sit tight and keep seeing patients. Three weeks after I received the notice, I was terminated because the CEO who had signed my contract said he did not know I was a felon when they hired me.
My licensing attorney was friends with the entire administration, and he initiated conversations and described my history, which led to their interest in hiring me. I personally informed the same people, and I was interviewed in person, and a contract was offered and signed. The office submitted the credentialing forms under the direction of the chief operating officer and included my history of felony and addiction. They had complete and indisputable knowledge of my history. During the month after receiving my termination notice signed by the vice president and delivered in person by the COO, there were multiple attempts to convince the CEO to change his mind. These attempts were unsuccessful, and the CEO kept to the story; he did not know I was a felon. I wrote a letter of appeal and called the OIG exclusion office, but they informed me the appeal time had expired.
There are three ways to overcome the OIG exclusion. You can file an appeal. You can obtain a waiver from the same people who excluded you, and I will describe this process and its futility. A presidential pardon will remove the felony, and the OIG exclusion is then ended. The state Medicaid director for both states I have medical licenses has submitted requests for a waiver. The OIG has granted a Medicaid waiver, but Medicare has denied it for small, underserved communities in both states. I have been talking with the small town of Aurora, Nebraska, which has three full-time physicians and one part-time. Medicare denied the waiver request because they said there were 49 family physicians in Aurora and 14 unique family practice offices in town. (There is one practice, and there never were or will be that many physicians in Aurora; according to Nebraska DHHS, there are only seven physicians in the entire county.)
They also said there are 348 family doctors in a town 30 miles away and 114 unique family practice offices. When confronted with the inaccurate numbers, the OIG exclusion office said they do not dispute the numbers from the Medicare people. A similar response was received for a town of 200 people in rural North Carolina. So two communities with difficulty recruiting and maintaining physicians cannot receive the care they deserve, and I was willing to provide.
My request for a presidential pardon was supported by a Nebraska Congressman that is no longer in office, so I was informed the request is just sitting in the Department of Justice. Not one Nebraska Congressman or Senator is willing to help, some have directly said no, and most will not return multiple phone calls or emails. Before me, no physician in Nebraska had been indicted for diverting, stealing, or buying illegal drugs on the street. The U.S. attorney who prosecuted me has a history of two DUIs and is recovering from an alcohol use disorder. My licensing attorney in North Carolina informed me no physician had been indicted for diverting a narcotic.
If you are charged with a felony, my advice is not to accept a plea deal. I believe a jury would have understood the disease of addiction and the resulting behaviors better than our legal system. I have been in recovery for 62 months, and I cannot practice my profession.
Jeffrey L. Fraser is a family physician.