In a significant victory for a healthcare provider, Frier Levitt successfully reversed the Centers for Medicare & Medicaid Services (“CMS”) revocation of a provider’s Medicare enrollment and billing privileges.
Like many providers who work in a niche area or are deemed “outliers” for treating complex patients, the provider had been the subject of multiple audits by the CMS over the years. Although the audits were abusive and numerous, the provider fought every audit and appealed the incorrect unfavorable findings.
While audits place an immense burden on healthcare providers and practices, the risk of simply accepting the auditor’s findings and paying to “get rid of the problem” can lead to far more serious issues.
In the case of this provider, after years of being audited, the CMS unexpectedly, while the administrative appeals process was still pending for multiple audits, decided to revoke the provider’s Medicare enrollment and billing privileges under 42 CFR §424.535(a)(8)(ii), Abuse of Billing Privileges. This decision threatened to disrupt the provider’s ability to serve their patients and maintain the financial viability of the practice. In the case of providers who rely heavily on Medicare, such an action can end a practice.
Frier Levitt’s healthcare attorneys acted immediately, recognizing the urgent need to protect the provider’s interests. In addition to preparing a comprehensive reconsideration appeal that included strategically crafted legal arguments, we contacted Assistant United States Attorneys (AUSAs) to intervene in this unjust action. The firm alerted the AUSAs to the situation, providing them with detailed information and actively advocating for the reversal of the CMS’ decision.
The firm’s multifaceted approach paid off, as Frier Levitt achieved a significant victory for the healthcare provider. The provider’s Medicare Provider Transaction Access Number (PTAN) was reactivated, with the effective date restored to the period prior to the revocation. This outcome ensured there were no interruptions in the provider’s billing privileges, allowing the practice to continue serving its patients without disruption.
A key factor in overturning the revocation decision was that the practice had multiple pending audits. Therefore, as the audit findings were still being contested and due process had not run its course, the CMS’ revocation action was irrefutably premature. If the practice simply paid the overpayment demands and accepted the negative findings, it likely would have resulted in a much different outcome.
Frier Levitt attorneys consistently represent healthcare providers in defending Medicare enrollment and billing suspensions and revocations. With their extensive experience in this field, the firm is well-equipped to handle the legal challenges posed by the CMS.
If your medical practice receives a notification of a suspension or revocation of billing privileges, it is crucial to seek the guidance of an attorney who specializes in healthcare law. Early intervention is essential, as it allows for a proactive approach and increases the likelihood of a successful outcome.
Contact Frier Levitt today to speak with an attorney who can provide the necessary expertise and support to navigate through these complex situations and protect the interests of your practice.
