Another Victory for Medical Providers against Medicare
LakinChapman, LLC recently obtained another successful result before the Department of Health and Human Services, Office of Medicare Hearings and Appeals in a case concerning an improper "post-payment review" of a provider's medical charges. This time, no hearing was required - thereby decreasing the provider's costs of recovery.
Under the Medicare laws, medical providers who service patients under Medicare are subject to retroactive review by third party bill review companies. This too often leads to a situation where the "contractor" wrongly forces a provider to repay thousands of dollars in alleged "overpayments" based on "insufficient documentation," and then the provider has to go through a lengthy appeal process while Medicare holds the money. In the current economic and fiscal climate, many providers are fearful that these reviews will increase as a way to cut costs under the rubric of combating "wasteful spending." This process can be extremely costly and time-consuming for the provider, confusing for patients, and can be damaging to the doctor-patient relationship. More importantly, "qualified independent contractors," who reconsider the contractor's decisions, often get the results wrong, and force doctors to repay money that the doctors are entitled to.
We won a fight on August 17, 2009, with a "WHOLLY FAVORABLE" ruling from a U.S. Administrative Law Judge. Our client was successful in aggregating the "cases" of 25 patients, known as "Beneficiaries" in this process. The Decision states, "[i]n this case, the [provider] has submitted sufficient documentation of the treatment that he provided to each of the 25 Beneficiaries herein on subsequent visits to his office. The [provider], therefore, has satisfied the requirements as set forth in the manuals and the Contractor's own local coverage determination. Accordingly, the services provided to the Beneficiaries herein are covered by Medicare." The Administrative Law Judge issued his order concluding that the provider was entitled to reimbursement.
LakinChapman, LLC regularly represents medical providers and consumers in class action litigation. Those seeking more information may contact the firm at medicalbillreview@lakinchapman.com (medical providers) or classaction@lakinchapman.com (consumers), or call (800) 851-5523. You may also visit our website http://www.lakinchapman.com/ for updates regarding significant events that have occurred in medical billing litigation as well as other litigation that may interest you.
