Frier Levitt successfully overturned a Medicare contractor’s denial of a pharmacy’s enrollment application to participate in the Medicare program as a Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) supplier. If forced to resubmit an enrollment application, the pharmacy would have restarted the waiting period for processing of the application, further delaying the pharmacy’s ability to dispense necessary DMEPOS to its patients.
The contractor denied the application because the pharmacy allegedly did not demonstrate compliance with the specific enrollment requirements unique to DMEPOS suppliers, as set forth under 42 C.F.R. 424.57(c) (the “DMEPOS Supplier Standards”), during the site inspection. In this case, like many others, proofs of compliance with the DMEPOS Supplier Standards were available for review by the surveyor, had they been requested during the site inspection.
The Importance of Engaging Experienced Legal Counsel
Following the issuance of the denial notice, Frier Levitt initiated an appeal through the submission of first, a Corrective Action Plan, and second, a Reconsideration Request. The firm’s attorneys are well-versed regarding the issues that may arise during a site inspection, as well as the proofs required to demonstrate compliance with Medicare enrollment requirements. Frier Levitt leveraged this knowledge and applicable laws to demonstrate that the pharmacy’s various proofs, which fully satisfied the DMEPOS Supplier standards, should have been considered during the site inspection. Ultimately, Frier Levitt successfully argued that based on the facts and circumstances of this case, denial of the application was not warranted under 42 C.F.R. § 424.530(a)(1) because the pharmacy was, in fact, fully compliant with the DMEPOS Supplier Standards.
Key Takeaways – Medicare Enrollment Application Denials
Often, pharmacies receive no notice of requested information that would demonstrate compliance during the site inspection, and thereafter, receive a denial notice for failure to demonstrate compliance with the DMEPOS Supplier Standards. It is critical that DMEPOS Suppliers maintain policies and records responsive to each DMEPOS Supplier Standard. In addition, applicants must retain detailed notes of site inspections to help rebut allegations that they were not in compliance with Medicare enrollment requirements during their site inspection.
Navigating the appeals process requires a thoughtful approach. Representation by experienced legal counsel may avert the need to submit a new enrollment application and avoid the delay in the provision of services to the DMEPOS Supplier’s patients.
How Frier Levitt Can Help
Our attorneys regularly counsel provider clients regarding enrollment, termination, and/or audit issues related to state and Federal health care programs. If you have questions about enrollments, terminations, or audits, or you have received a revocation notice from Medicare or Medicaid, contact Frier Levitt to speak with an attorney.
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