As part of its fight against fraud, waste and abuse, CMS contracted with supplemental medical review contractors to perform and/or provide support for a variety of tasks, including performing audits.  As part of their responsibilities, these contractors perform audits to identify overpayments.  Among the many projects being worked by these contractors, is a current review of chiropractic services which HHS OIG previously identified as an area of concern due to significant numbers of questionable claims.

After the Firm’s client received a request for records from a supplemental medical review contractor, the Firm was retained by the chiropractic practice to assist in the production of records.  Following a review of the records, the Firm prepared a written response to accompany the chiropractic records which included an explanation of the applicable Medicare policies and guidelines.  The Firm successfully argued that Medicare policies and guidelines contemplate that documentation requirements may be satisfied through the combination of several different documents, and not just one isolated note from a particular date of service (as the contractor was proposing).  An expert report was also provided for some of the dates of service in issue.

After submitting the records, letter of explanation, and the expert report, the contractor determined that the chiropractic records, including all documents associated with the dates of service in issue, were sufficient to satisfy documentation requirements.  The contractor determined only two claims were overpaid due to technical deficiencies.

The law firm of Nicholson &, Eastin, LLP routinely represents individuals and group providers in the defense of Medicare, Medicaid and commercial insurance audits and overpayment appeals.  If you have received an unusual request for records, or an overpayment demand, please do not hesitate to contact us to evaluate your matter.