Medicare(WPS) Audit - Judgment
Victory against Improper Medicare/WPS Audit
LakinChapman, LLC recently obtained a successful result before the Department of Health and Human Services, Office of Medicare Hearings and Appeals in a case concerning an improper bill review audit of a provider's medical charges. "This case shows that the third-party auditors for the Medicare bureaucracy can be beat," said Brad Lakin, managing partner at LakinChapman, LLC.
Under the Medicare laws, medical providers who service patients under Medicare are subject to retroactive audits by third party bill review companies like Wisconsin Physician Services (WPS). This too often leads to a situation where WPS 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 audits 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, WPS and other auditors often get the results wrong, and force doctors to repay money that the doctors are entitled to.
We recently won a fight against this process. LakinChapman, LLC successfully represented Dr. Frank C. Bemis & Associates, Chiropractors, S.C. ("Bemis & Associates") in an appeal of WPS' "repayment" finding with regard to subsequent office visits for several patients (CPT Code 98942). After a hearing, on March 5, 2009, the Administrative Law Judge issued his order concluding that Bemis & Associates were right, WPS was wrong, and the "overpayment" should be refunded by Medicare to Bemis & Associates. The Judge's ruling was "FULLY FAVORABLE" for Bemis & Associates. After an extensive legal analysis, the Judge found that the documentation submitted by Bemis & Associates was totally sufficient, and that WPS was imposing the wrong documentation standards, confusing the requirements of initial and subsequent visits. The Judge noted in passing that the documentation forms submitted by Bemis & Associates were developed in consultation with Medicare and accepted for years. As the Judge's Order states: "The carrier has been accepting the form for years. Suddenly, the carrier wants the Appellant to document each office visit as if it were the initial visit with the patient."
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.
