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Medicaid and Medicare overpayment Defense Lawyers

Healthcare providers including physicians and their medical practices exist in a regulatory environment. All these healthcare providers including are under more scrutiny than in prior years. While the Centers for Medicare and Medicaid Services (CMS) have had the opportunity to examine, accept or deny services deemed to be wrongfully billed, healthcare reform exists. As the result of healthcare reform, the healthcare lawyers at The Weaver Law Firm is positioned to defend and represent various health care segments including but not limited to industry segments, including physicians, their medical practices, skilled nurses, memory care facilities, rehabilitation facilities; assisted living and seniors housing communities, continuing care retirement communities (CCRCs); home care agencies; hospices; nursing homes, adult day healthcare providers; gerontological and other medical professional services providers

Receiving notice of an alleged “overpayment” from one of CMS’ contractors or another payor should trigger a call to a Texas healthcare lawyer. Sometimes the need for an appeal is necessary, but not in all cases. Still, the appeals process should be taken seriously and with the assistance of an experienced attorney. A healthcare provider does not need to be burdened with handling the process without a lawyer. Legal and procedural arguments should be made by a lawyer experienced in representing doctors and medical care facilities.

What is a Medicare Overpayment Request?

Medical providers are rightly entitled to be paid for their services. A Medicare overpayment occurs when Medicare reimburses money to a provider in an amount that is more than what that provider is should rightfully collect according to the Medicare laws and regulations. These Medicare overpayments are funds that the providers hold and that Medicare seeks to recover from the healthcare provider. A healthcare lawyer with experience in Medicare overpayments can give you more information.

How can a healthcare provide contest an Overpayment Demand?

Once a Medicare Administrative Contractor (MAC) finds out that a physician or medical provider received an overpayment, the authority can legally try to recover the overpayment amount. The MAC usually will begin the process by sending a demand letter to the healthcare provider. Send this demand letter to your healthcare attorney so he can give you the best options on what to do next. What can you expect to see in the MAC demand letter? The Demand Letters inform the medical providers on the amount of money claimed as owed to Medicare. It should contain a description of the provider’s repayment options and identify the rights the healthcare provider has in order to contest the Medicare Administrative Contractor’s determinations.

What can you do? There are several options and levels. You could make a rebuttal. A rebuttal gives the provider an opportunity to identify conflicts, issues and incorrect statements contained in the MAC demand letter. The healthcare lawyer assisting on the process can highlight the MAC’s incorrect statements and provide evidence in defense of the medical provider.

Since a healthcare provider has 120 days from receipt of the Demand Letter to file a request for redetermination, the provider should contact an experienced healthcare lawyer as soon as possible. By giving the healthcare lawyer advance notice, the provider and the lawyer will have time to work together to prepare for the rebuttal. An attorney can assist a provider that disagrees with any revised determination by asking the MAC to reconsider the findings.

What can you do if you do not agree with the Qualified Independent Contractor’s (QIC) reconsideration decision? You can ask for a hearing before an Administrative Law Judge (ALJ). This is handled by the Office of Medicare Hearings and Appeals, which is why an attorney with healthcare experience should participate in the process.

The Medicare Appeals Council has specialized knowledge and experience in Medicare laws and regulations. They would be who would address and review the next stage of appeal.

The last option would be for the medical care provider to challenge an overpayment by arguing before a federal district judge.

Call A Healthcare Lawyer If You Get an Overpayment Demand

Practitioners in the medical industry may find themselves in a difficult position if the United States Treasury Department initiate collections. They may attempt wage garnishment or other types of aggressive collections. A Texas lawyer with experience in collection defense and the medical industry can help. The attorneys at The Weaver Law Firm can help. You are invited to call us at 713-572-4900.