As a condition to ongoing participation in the Medicare Program, DMEPOS Suppliers must maintain compliance with specific standards set forth under 42 C.F.R. 424.57(c) (hereinafter, the “DMEPOS Supplier Standards”). Failure to adhere to the DMEPOS Supplier Standards can result in a notice of revocation from Medicare (“Termination Notice”) with a limited period to submit an appeal, often referred to as a “Reconsideration Request”, and an even shorter time period to submit a corrective action plan (“CAP”) to the applicable Centers for Medicare and Medicaid Services (“CMS”) appeals contractor for review. Absent good cause for missing these deadlines, the termination decision will be deemed final, and providers who disregard the Termination Notice will no longer be able to participate in the Medicare program for at least one (1) year, the minimum time period associated with a “reenrollment bar.”
In light of the serious implications stemming from an unchallenged Termination Notice, the value of experienced legal counsel cannot be overstated. Frier Levitt has a track record of success in navigating these critical enrollment issues by meticulously rebutting factual allegations of noncompliance and demonstrating the providers’ good faith efforts to implement appropriate corrective actions to prevent reoccurrence of noncompliance.
Frier Levitt has secured numerous favorable decisions on behalf of our clients facing termination of their enrollment as DMEPOS suppliers. In recent matters, Frier Levitt was able to demonstrate that the supplier did not fail to maintain compliance with various DMEPOS Supplier Standards, which were the underlying basis of CMS’ decision to terminate, such as the requirements to: (i) maintain a surety bond; (ii) ensure that the supplier’s physical facility is accessible to the public during the posted hours of operation; and (iii) pass an on-site inspection to demonstrate that the supplier complies with the DMEPOS Supplier Standards. With the involvement of legal counsel, these suppliers were able to completely reverse CMS’ decision to terminate enrollment in the Medicare Program. As a result, these suppliers were able to continue dispensing DMEPOS to their patients without any disruption to care, while also avoiding a Medicare reenrollment bar and, in some instances, clawbacks of previously paid claims. Medicare revocations commonly trigger corresponding state Medicaid program terminations, but because their Medicare appeals were successful, the clients in the foregoing examples were also able to avoid an automatic Medicaid termination.
How Frier Levitt Can Help:
Our attorneys regularly counsel providers on a variety of enrollment, termination, and/or audit issues related to state and Federal health care programs, including, but not limited to, issues affecting providers who dispense DMEPOS. 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.
