Respiratory therapists and other health care providers frequently have licenses in more than one state. Health care providers, including RTs, also move into nontraditional roles that may not necessarily require them to maintain an active license to perform their jobs.

Occasionally, a licensing board will seek to discipline one of those old licenses, and the practitioner will surrender the license because it seems easier than resolving the problem -however minor - with the licensing board. Most health care providers don't know that surrendering their license can result in exclusion from participation in Federal health care programs by the Office of Inspector General (OIG), which can prevent the provider from working in almost every health care setting. RTs should think twice about surrendering an "unnecessary" license.

The OIG is the enforcement arm of the Department of Health and Human Services (HHS).  The OIG's job is to protect HHS programs, including the Medicare and Medicaid programs, from fraud and abuse.  One of the ways the OIG protects HHS programs is by excluding individuals who pose a threat to those programs. 

There are two types of exclusion imposed by the OIG - mandatory and permissive. The OIG must exclude a practitioner when the practitioner:

1. is convicted of a program related crime

2. convicted of a crime related to patient abuse or neglect

3. convicted of a felony related to health care fraud

4. convicted of a felony relating to controlled substances. 

The OIG may exclude a practitioner when the practitioner:

1. is convicted of a misdemeanor relating to health care fraud

2. is convicted of a crime relating to obstructing an investigation

3. is convicted of a misdemeanor related to a controlled substance

4. has their license to practice suspended or revoked

5. has defaulted on a health education loan or scholarship obligation.

The permissive exclusion for having an old license suspended or revoked has caused severe problems for numerous health care providers including RTs.

Licensing boards seek to discipline licensees for serious offenses as well as more minor offenses and rightfully so. A less serious offense, such as failure to submit proof of continuing education hours, or failing to keep a current address with the board, frequently can be resolved with the licensing board without having the license surrendered or revoked.

Most licensing boards also will allow practitioners to surrender their license in lieu of discipline regardless of how minor the offense. Surrendering a license while under investigation, for even a minor offense, will most likely result in revocation of the license and in the practitioner's exclusion by the OIG.

Many providers elect to surrender an "unnecessary" license because it appears to be cheaper and easier than resolving the matter with the licensing board.  Those health care providers often get a rude awakening when they are notified by the OIG that they have been excluded from participation in all Federal health care programs based upon surrendering their professional license.

The effect of a OIG exclusion is that no Federal health care program will pay for services provided by the excluded individual. The payment exclusion includes payments for administrative and management services that are not directly related to patient care, but are part of providing the Federal program services. Practice settings that do not accept any Federal health care program dollars are few and far between. As a result, an excluded health care provider will be unable to work in most if not all health care settings.

Employers that rely on Federal program payments will not risk keeping an excluded individual on the payroll. In fact, most health care employers are required to regularly verify that none of their employees has been excluded by the OIG as part of their compliance plans. Consequently, an excluded provider will most likely be scrambling to find any type of employment while trying to unravel the calamity that resulted from surrendering the "unnecessary" license.

Excluded individuals also cannot take a sabbatical and wait for the OIG exclusion to expire. The OIG exclusion authorities provide the required length of exclusion for each offense. The exclusion period for the suspension or revocation of a license is never less than the period of revocation or suspension.  As a result, an excluded provider is faced with the daunting task of trying to regain their license before the OIG will even consider removing the exclusion. The time and expense necessary to undo a revocation or suspension is significantly more than the time and expense that is required to resolve the initial problem with the licensing board.

RTs should know all of the repercussions that may result from surrendering a license.

Michael L. Smith, JD, RRT is board certified in health law by The Florida Bar and practices at The Health Law Firm in Altamonte Springs, Fla. This article is for general information only and is not a substitute for formal legal advice.