Redetermination Appeal Results in Substantial Reduction of Medicare Overpayment

Posted on Firm News by Erin Ferber

After submitting a detailed redetermination appeal on behalf of our client’s medical practice, the Firm secured a significant reduction in the overpayment demand – more than a 95% reduction.  In addition to addressing the support for the billed services found in the relevant medical records, the Firm also addressed the statistical sampling methodology used by the Medicare contractor.  The Firm’s analysis revealed that the sample was not a statistically valid random sample and argued that the extrapolation did not comply with Medicare rules and regulations.  The Firm successfully challenged the legitimacy of the sample and extrapolation methodology on appeal, resulting in a reduction in the overpayment from more than $1,000,000 to approximately $3,200.

The law firm of Nicholson &, Eastin, LLP, routinely represents individuals and medical 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.