PROVIDER ALERT: Medicare Advantage Organizations Have Been Wrongfully Terminating Physicians with Little to No Notice and Little to No Cause

In recent months, Medicare Advantage Organizations (MA Organizations) across the country have been on a network termination binge – often terminating physicians without sufficient (or sometimes any) notice and opportunity to appeal. These terminations have been effectuated by, among other means, denying physicians’ recredentialing applications, with MA Organizations offering very little in the way of legal justification. 

The Centers for Medicare and Medicaid Services (CMS) have promulgated regulations specific to Medicare Advantage designed to ensure that procedural due process is afforded to physician-participants prior to their termination from the program. 42 C.F.R. 422.204(a) for example, provides that an MA Organization “must have written policies and procedures for the selection and evaluation of providers” and, overlapping therewith, 42 C.F.R. 422.202(a) states that an MA Organization, prior to terminating a physician, must provide “reasonable procedures” that include “[w]ritten notice of rules of participation including terms of payment, credentialing, and other rules directly related to participation decisions . . .”  Id. (Emphasis supplied). Plainly, arbitrary and/or notice-deficient terminations of providers by MA Organizations are violative of federal law, and providers can use this law to strike back at abusive MA Organization practices. 

To effectively take advantage of the many Medicare Advantage regulations that protect providers from unlawful termination, it is critical that providers hire competent healthcare attorneys with a deep knowledge of this niche area of the law. Frier Levitt, a national boutique healthcare law firm, has such knowledge, in addition to having significant experience in advocating on behalf of providers on precisely these issues. Just this month, Frier Levitt succeeded in assisting a thriving specialty medical practice in avoiding the substantial financial and reputational harm that would have followed network termination from a nationwide carrier’s Medicare Advantage networks. The firm, bringing its specialized healthcare knowledge to bear in targeted correspondence to the carrier’s counsel and appeal panel, convinced the carrier to reverse the impending Medicare Advantage termination without ever having to file suit, saving the client an enormous sum in future lost reimbursements, potential legal fees and reputational harm.

Contact Frier Levitt today to speak to an attorney.

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