Medicare Overpayment Reversed in Rare Application of Provider Being Found to be Without Fault by Administrative Law Judge

Posted on Firm News, Medicare Reimbursement by Robert Nicholson

After almost seven years of navigating the administrative appeals process, the Firm secured the complete dismissal of a $1,000,000 dollar Medicare overpayment for a South Florida physician.  Following the physician’s receipt of untimely overpayment demands, the Firm secured the reinstatement the provider’s appellate rights.  The gist of the overpayment demand was that the provider failed to provide records in response to a records request.  The records, however, had been destroyed prior to the time the request was received.  Senior Associate Erin Ferber successfully challenged the overpayment demand on both legal and statistical grounds.  Following a two-day evidentiary hearing, the ALJ found that “payment can be made on all claims under §1879 of the Act” and that the provider “is without fault and entitled to a waiver of repayment under §1870 of the Act.” This case represents a rare application of the without fault rules by an ALJ.

The Florida health law firm of Nicholson &, Eastin, LLP, routinely represents individuals and group providers in the defense of Medicare audits and overpayment appeals.  If you have received a request for records from a Medicare contractor, or an overpayment demand, please do not hesitate to contact us to evaluate your case.