Frier Levitt successfully defended a national telehealth company providing remote patient monitoring (RPM) and chronic care management (CCM) services to Medicare beneficiaries with multiple chronic conditions. Without prior warning or an opportunity to respond before the suspension took effect, a Centers for Medicare & Medicaid Services (CMS) contractor imposed a full suspension of all Medicare payments, based entirely on unsubstantiated allegations of fraud.
For a practice whose revenue was predominantly derived from Medicare, with no meaningful alternative revenue sources, the payment suspension threatened the practice’s continued operations. A shutdown also threatened to disrupt care for vulnerable elderly patients who relied on daily monitoring to manage multiple chronic conditions.
Building a Robust CMS Payment Suspension Rebuttal
The first line of defense began with the immediate filing of a comprehensive rebuttal, supported by an expert report from Empower Healthcare and Compliance Partners (EHCP), which addressed the CMS contractor’s allegations on multiple fronts.
The suspension rested on two primary claims. The first claim, that the practice billed Medicare for items never supplied, was based on a single unattributed beneficiary interview. The team’s investigation identified the beneficiary, who ultimately located the unopened equipment package and assisted in refuting the allegation.
The second allegation, that CMS was billed for medically unnecessary services, relied on claims that had already been denied through the CMS contractor’s prepayment review process and for which no payment was ever made. The team identified a critical inconsistency: the contractor had deactivated its own prepayment edit in December 2025, only to impose a full fraud-based payment suspension five months later, a timeline that raised questions about a determination that the practice posed an ongoing fraud risk. EHCP’s independent, beneficiary-by-beneficiary review confirmed that the documentation substantially supported the medical necessity and performance of the services for every cited patient.
The rebuttal further identified significant due process concerns, including the absence of prior notice, contradictory investigative actions, and evidence that, according to the practice’s rebuttal, called into question whether the allegations underlying the suspension had sufficient indicia of reliability when the suspension was imposed.
Seeking Emergency Injunctive Relief
While the rebuttal was comprehensive, the practice faced an immediate financial crisis while awaiting administrative review. Recognizing the urgency, Frier Levitt helped the practice pursue emergency judicial relief.
Shortly after filing the formal rebuttal, Frier Levitt’s Government Investigations, Litigation & White-Collar Defense Group filed a motion for a temporary restraining order and preliminary injunction. The motion argued that the practice was likely to succeed on the merits because the fraud allegations underlying the suspension lacked the “indicia of reliability” required under federal regulations; the company faced irreparable harm from the complete elimination of its revenue stream; and the public interest favored preserving beneficiary access to monitoring services for elderly, at-risk patients with multiple comorbidities.
The coordinated strategy produced a swift result. Within days of the injunction filing, government attorneys directed the CMS contractor to terminate the payment suspension and release all held funds.
Key Takeaways for Providers Facing CMS Payment Suspensions
In just 18 days, Frier Levitt challenged the CMS contractor’s allegations, built an independent compliance record, and sought emergency relief in federal court, forcing CMS to reverse course before the practice, and the vulnerable Medicare beneficiaries who depended on it, suffered irreparable harm. Within days of the injunction filing, the payment suspension was terminated, and the withheld funds were released, avoiding the threatened disruption to the practice and its Medicare beneficiaries.
At first glance, the allegations and tone of the CMS contractor’s suspension letter presented serious concerns. Yet a closer review of the evidence behind those allegations revealed significant weaknesses in the factual basis supporting them. If your practice receives an unfavorable letter from a CMS contractor, whether tied to an audit, payment suspension, or termination, it is important to conduct a thorough independent review and carefully evaluate the findings.
The defense strategy employed by Frier Levitt combined regulatory, compliance, and litigation experience in a coordinated response. The matter illustrates how an integrated strategy can strengthen both the administrative record and the basis for seeking judicial relief when circumstances warrant it.
For providers facing CMS payment suspensions, this case illustrates the importance of building a thorough administrative rebuttal that addresses the evidentiary basis of the suspension or termination head-on, retaining independent compliance experts where appropriate to evaluate clinical documentation, and, when the administrative timeline cannot keep pace with immediate financial or patient-care risks, considering whether to pursue immediate injunctive relief in federal court based on the evidentiary record. The combination of a well-developed administrative record and timely judicial intervention may help accelerate resolution in appropriate circumstances. Although this strategy may not be appropriate or available in every payment suspension or termination matter, a prompt, evidence-based response can be critical to protecting a provider’s operations, reimbursement, and continuity of patient care.
How Frier Levitt Can Help
Frier Levitt represents healthcare providers facing CMS payment suspensions, audits, overpayment demands, and other government investigations and enforcement actions. Our attorneys work across regulatory, compliance, and litigation disciplines to evaluate the allegations, develop a strong evidentiary record, prepare administrative rebuttals, and, when appropriate, pursue emergency judicial relief. If your organization is facing a Medicare payment suspension or other action that threatens reimbursement or continued operations, contact Frier Levitt to discuss your options and develop a coordinated response.
