Navigating Claims On Behalf Of The Medicaid And Medicare Recipients
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 Strause Law Group, PLLC, a significant focus of our firm is health care regulatory law. Our lawyers counsel our clients through Medicaid audits, handling any threatened recoupment and reimbursement issues, which are often associated with a variety of waiver and demonstration grant programs. Some examples are:
- Kentucky Transitions (Money Follows the Person Demonstration Grant) Program
- Supported Community (SCL) Living Waiver Program
- Home and Community-Based Services (HCBS) Waiver Program
- Long-Term Care (LTC) Waiver Program
- Acquired Brain Injury (ABI) Waiver Program
- Michelle P Waiver Program
Recoupment Of Alleged Medicaid Overpayments
Recoupments of alleged overpayment can have a devastating effect on your business, so it is critical to challenge these determinations successfully. If you are facing an allegation, we can help you take steps to address this issue.
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. For a DRM request to be granted, the request must be timely filed and meet strict regulatory guidelines. With our assistance, you can be confident that you meet these necessary guidelines and deadlines.
If the DRM does not produce the desired result for our clients, we will file an administrative appeal of the DMS determination. The appeals process provides you with an administrative hearing, a formal hearing conducted in accordance with KRS Chapter 13B. Our attorneys have successfully negotiated on behalf of clients in mediation and have effectively represented many clients throughout the administrative appeals process.
At Strause Law Group, PLLC, in Louisville and Lexington, Kentucky, our attorneys understand the critical 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. We have substantial experience with 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
- Fraud and abuse allegations
- Program participation issues
Recoupment Of Alleged Medicare Overpayments
A common problem we handle on behalf of our clients is 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 Medicare alleges your business received payments it should not have been entitled to, and you do not quickly challenge that determination, your business will be found 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 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 appeals 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 to advocate for your business’ interests.