Frier Levitt recently assisted a medical practice in challenging and completely overturning a Medicare Advantage Organization’s (MAO) without cause termination from one of its Medicare Advantage (or “Part C”) lines of service.
Without cause terminations by MAOs and other payors offer limited avenues for appeal. Because no specific allegations underlie the termination, there is no obvious target to attack, making these disputes considerably harder to fight than for cause terminations. But providers are not without recourse. Certain regulatory protections and legal rights remain available, and a well-developed strategy can make all the difference.
Leveraging Medicare Advantage Regulations to Reverse Termination
In this matter, Frier Levitt leveraged the unique regulatory framework governing MAO provider terminations, a framework that imposes specific procedural and substantive requirements on MAOs well beyond those found in standard commercial payor contracts. The firm argued that the MAO had violated these requirements and further threatened a variety of statutory and common law claims, including breach of contract and anti-competition violations.
The firm also identified network adequacy concerns created by the termination and marshaled patient attestations to underscore the provider’s importance to the plan. The result: a complete reversal and rescission of the termination notice.
Key Takeaways for Providers Facing Termination
Although without cause terminations can be difficult to dispute, there may be more options available than simply writing off the termination as bad luck. This is particularly true in the Medicare Advantage context, where the federal Medicare Advantage program’s comprehensive regulatory framework imposes distinct obligations on MAOs that can serve as powerful tools for providers facing termination. Whether the basis for seeking rescission is rooted in regulatory noncompliance, breach of contract, anticompetitive conduct, network adequacy concerns, or other factors arising from the totality of the circumstances, an experienced attorney may be able to assist a practice by performing a full analysis of the facts and disputing the termination.
How Frier Levitt Can Help
If your practice has received a without cause termination, whether from a Medicare Advantage Organization or another payor, do not write it off; potential avenues for reversal may exist. Frier Levitt has extensive experience representing healthcare providers in network disputes, terminations, and complex payor matters, including Medicare Advantage plans. Our team understands the regulatory frameworks, contractual nuances, and strategic considerations necessary to challenge adverse actions and protect your practice’s ability to operate. Contact Frier Levitt today to speak with an attorney about your options and develop a strategy tailored to your situation.
Senior Associate
- Healthcare Payment and Reimbursement Models
- Healthcare Practice Compliance
- Insurance Defense
- Medicare Audit Appeals
- Medicare, Medicaid, and Commercial Payor Audits and Appeals
- Payor Network Access and Defense of Network Terminations
- Physician and Medical Practices
- Physicians and Medical Practices of all Specialties
