Who Can Request An Exclusion Waiver?

Authorized Requester

Only the administrator of a Federal or state health care program (e.g., Medicare or Medicaid director) can request an exclusion waiver. The request cannot come directly from the excluded individual or entity. The administrator must be “directly responsible” for administering the program under specific, limited circumstances. 

Typically, the process involves the excluded provider submitting the request to an agency administrator, who then forwards it to the Office of Inspector General (OIG).

The OIG’s authority to grant a waiver is outlined in 42 C.F.R. § 1001.1801, et seq., and the requirements vary depending on whether the exclusion is mandatory or permissive. 

Obtaining a waiver is generally considered difficult, therefore, even though states can request waivers, most don’t because:

• The administrative process is complex and slow.
• They can face scrutiny from the OIG or auditors.
• It’s usually easier and safer to find another provider or wait for reinstatement.

Conditions for Requesting a Waiver

There are two types of OIG Exclusions – Mandatory and Permissive, each with separate conditions for requesting a waiver. 

Mandatory Exclusions are identified in Sections 1128(a)(1) – 1128(a)(4) of the Social Security Act (SSA), (42 U.S.C. §1320a-7(a)(1)-(4)), and they are imposed as a result of convictions for program fraud, patient abuse, and certain drug offenses. 

Permissive exclusions, on the other hand, are discretionary and can be imposed for a broad range of conduct. These are identified in §1128(b)(1)–§1128(b)(16) and §1156 of the Act.

Mandatory Exclusion Waiver

For exclusions based on mandatory grounds such as fraud or program-related crimes, the Federal healthcare program Administrator has the authority to request a waiver from the OIG. It is crucial to note that an Administrator cannot seek an exclusion waiver if the mandatory exclusion was based on a conviction under Federal or State law related to the neglect or abuse of a patient.

A waiver may be requested only if:

• A state Medicaid agency identifies that an excluded doctor is the sole specialist in a remote area.
• The exclusion would cause hardship to program beneficiaries.

Permissive Exclusion Waiver

For less severe violations, the administrator can request a waiver if the OIG determines that excluding the provider “would not be in the public interest.”

For an in-depth explanation to OIG Exclusions, visit our guide, A Provider’s Guide to OIG Exclusions. For a shorter overview, visit our article What is an OIG Exclusion?.

Extent of a Waiver

The agency administrator may then request a waiver from OIG to allow that provider to treat Medicaid patients under specific, controlled circumstances.

If approved, the waiver applies only to that specific agency or program in which it was requested. It defines the exact services and geographic limits of participation — for example, certain office visits, hospital stays, or prescribed items. The waiver may limit care to a specific geographic region or to a medical specialty.

The OIG grants waivers only when necessary to prevent hardships to beneficiaries.
These hardships are typically localized, such as:

• A rural hospital being unable to find another specialist.
• A remote nursing home having only one available provider for a critical service.

Thus, the waiver is confined to the specific area where the hardship exists — not the provider’s entire practice area or across multiple programs.

Waivers may be rescinded at any time if the justification (e.g., provider shortage) no longer exists.

Difficulties and limitations of an exclusion waiver

Waivers Are Rarely Granted

Exclusion waivers are exceptionally rare — There are only a handful in effect nationwide at this time (Oct. 2025). Waivers are only meant to be an extraordinary exception to protect patient access — not a mechanism to circumvent exclusion penalties. If they were easily approved and accessible it would undermine compliance from exclusions, allowing excluded entities to keep participating. The standards needed to be met for approval are narrow and few cases meet it.

Strict Approval Standards

The OIG holds complete discretion over approval. The decision to grant, deny, or rescind a waiver cannot be appealed — it is not subject to administrative or judicial review.

Limited Scope of Practice

Even if approved, a waiver only permits the provider to offer specific services defined in the waiver. Payment from Medicare, Medicaid, or other Federal programs is only allowed for those explicitly listed services. Because waivers are only granted when the physician or source is essential, it is very limited to the scope, specialized service within a specific geographic location or institution.

Not a Shortcut for Reinstatement

We emphasize that a waiver is not a way for an excluded provider to resume participation while waiting for reinstatement eligibility. Most excluded providers must wait until their exclusion period ends before applying for reinstatement. For a guide on reinstatement, visit our article, Applying for Reinstatement. 

Alternatives to a Waiver Request

Instead of seeking a formal waiver, providers sometimes explore continued employment of an excluded individual by requesting an Advisory Opinion from the OIG. These are often expensive and unproductive, typically granted only in “one-off” circumstances where the financial and reimbursement relationship between the participating provider and the excluded individual is extremely tenuous.