Skilled Legal Defense For Providers Navigating The Medicare And Medicaid Labyrinth
The Medicaid and Medicare programs are vast, complex and constantly shifting due to ongoing health care reform. For providers, this environment can feel like an labyrinth, yet regulatory agencies expect you to navigate it without error. At Strause Law Group, PLLC, we know health care regulatory law, providing the sophisticated counsel necessary to protect your practice. Whether your issue involves complex waiver issues in Kentucky or fraud allegations in South Carolina, our attorneys can help resolve recoupment disputes and safeguard your professional future.
Medicaid Regulatory Law And Waivers
At Strause Law Group, 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. Some examples are:
- Kentucky Transitions (Money Follows the Person Demonstration Grant) program
- Supports for 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
Our legal team provides the skilled oversight necessary to navigate these specific regulatory requirements, ensuring your facility remains in good standing while continuing to serve these vulnerable populations.
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.
Medicare Issues
Our lawyers 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. Our team has 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
- Underpayments
- Fraud and abuse allegations
- Program participation issues
Our attorneys provide the comprehensive guidance and technical advocacy necessary to resolve these complex Medicare issues and ensure your practice remains compliant and profitable.
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.
Examples Of Medicare/Medicaid Fraud
Our law office represents health care providers accused of Medicare fraud or Medicaid fraud involving a variety of actions:
- Fraudulent billing for services not rendered
- Fraudulent filling of prescriptions
- Administering unnecessary treatments
- Falsifying information
- Kickbacks or self-referrals
A conviction for Medicare fraud or Medicaid fraud, or an administrative finding of civil fraud, can have severe consequences – consequences that could affect your professional license. The attorneys at our firm will take measures to protect your professional license. Clients value our experience and perspective in handling Medicare and Medicaid fraud accusation cases, and our solutions-based approach saves time and money in addressing disputes.
Investigating Charges Of Administrative Fraud
Often, our clients are facing charges of Medicaid or Medicare fraud after making an honest mistake in the billing process. Many times, it is an administrative employee within the practice who made the mistake, but it is the physician who is ultimately held responsible. Understandably, these mistakes often happen due to the complex Medicare/Medicaid billing systems. We have experience analyzing these intricate billing systems, as well as other transactional records.
Secure Your Professional Future
Don’t face a complex audit or fraud allegation alone. Whether you need to challenge a recoupment or protect your medical license, our experienced health care defense attorneys are ready to help. Call 502-498-8268 or email us today to schedule your consultation.