Medicaid And Medicare Audits, Recoupment And Reimbursement

The Medicaid program is large, complex and ever-changing due to health care reform. At times it can appear to be a complicated labyrinth that seems impossible to navigate. However, for health care providers who service the Medicaid population, the Department for Medicaid Services (DMS) expects them to know all the twists and turns of this maze.

At The Strause Law Group, PLLC, a major focus of our firm is health care regulatory law. Our lawyers counsel our clients through Medicaid audits and handle any threatened recoupment and reimbursement issues that are often associated with a variety of waiver and demonstration grant programs. Some examples are:

  • Kentucky Transitions Money Follows the Person Grant Program
  • Supports Community Living Waiver Program (SCL)
  • Home and Community-Based Waiver Program (HCB)
  • Long-Term Care Waiver Program (LTC)
  • Acquired Brain Injury Waiver Program (ABI)
  • Michelle P Waiver Program

Recoupment Of Alleged Medicaid Overpayments

Our firm understands the devastating impact recoupments of alleged overpayments by DMS can have on providers and the important role challenging those determinations can play in the continued success of your business. When facing an allegation of overpayment, a provider can challenge the determination by first requesting a Dispute Resolution Meeting (DRM), which is akin to mediation.

In order for a DRM request to be granted, the request must be timely filed and meet strict regulatory guidelines. If the DRM does not produce the desired result for our clients, we would file an administrative appeal of the DMS determination. The appeal process provides you with an administrative hearing, a formal hearing conducted in accordance with KRS Chapter 13B. Our attorneys possess the requisite knowledge to negotiate on behalf of clients in mediation and effectively represent clients throughout the administrative appeals process.

Medicare Issues

At The Strause Law Group, PLLC, in Louisville and Lexington, Kentucky, our attorneys understand the important role Medicare plays in medical practices and health care businesses, specifically how essential prompt and accurate payments from Medicare are in the continued success of your practice. Health care regulatory law is a major focus of our firm; therefore, our attorneys are highly knowledgeable and experienced in handling matters that arise with participation and reimbursement in the Medicare program. We have represented clients in a variety of matters, such as:

  • Recoupment of alleged overpayments
  • Billing and coding issues
  • Reimbursement disputes
  • Underpayments
  • Fraud and abuse allegations
  • Program participation issues

Recoupment Of Alleged Medicare Overpayments

A common issue we handle on behalf of our clients is when a client is facing an allegation of overpayment by Medicare and the resulting recoupment of those overpayments. The responsibility for ensuring that all filing procedures are followed is placed in the hands of the provider. If your business received payments Medicare alleges it should not have been entitled to, without timely challenging that determination, your business will be found to be at fault and responsible for the repayment of those funds. An adverse determination of overpayment would likely result in reviews of billing being "red-flagged" for future review and recoupment.

At The Strause Law Group, PLLC, our attorneys have qualitative experience in handling these kinds of matters for our clients. We counsel our clients through the complex appeal process that providers must subject themselves to in order to challenge a determination of overpayment.

Take The First Step

Time is of the essence when challenging Medicaid and Medicare allegations of overpayment and recoupment. If your business is facing recoupment by Medicaid or Medicare for alleged overpayments, or any other legal issue relating to compliance with these programs, please contact our health care regulatory law attorneys who will advocate for your business' interests. Contact us online or call 502-498-8268 or 859-428-7029 to discuss your legal concerns.