Category Archives: Medicare Reimbursement

15 Sep

Appeal of UPIC Audit Overpayment Determinations – A Multi-Step Approach

Mr. Gaitan is available to discuss his strategies and legal costs, including hourly and contingency fee arrangements with provider’s who have received a records request or have received an overpayment determination and demand letter from their MAC or would like to more about the process. Initial consultation fee is waived. Feel free to contact Rafael (Ralph) Gaitan, Esq. at (786) 440-8115 or via email at rg@ragaitanlaw.com

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27 Jul

Successful Appeal of Medicare Extrapolated Overpayments – Saving Millions of Dollars.

Recently, the Firm has successfully challenged Medicare extrapolated overpayments resulting in various favorable decisions saving our clients (hospice and home health agencies) millions of dollars in overpayment amounts recouped by CMS or paid back via voluntary extended repayment plans. The Firm’s successful appeals resulted in complete removal of the statistical overpayments reducing any amounts owed

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29 Jan

Responding to the Omissions Notice.

The changes in Florida’s Medicaid enrollment and participation rules and regulations require that many previously unlicensed behavior analysis entities seek either licensure as health care clinic or seek exemption from licensure. See our previous post for additional facts regarding same here. As a result, many behavior analysis providers will need to file for licensure with

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29 Oct

How to Avoid Medicare Payment Interruptions After January 1, 2020

Attention Medicare providers! if you want to continue receiving Medicare payments without delay please ensure that your practice or billing provider is using MBIs for all Medicare transactions as soon as possible and prior to January 1, 2020. As you may recall, The Centers for Medicare and Medicaid Services (CMS) is requiring that “physicians, providers,

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18 Oct

Changes to the Amount in Controversy Thresholds for Medicare Appeals

Beginning on or after January 1, 2020, the amount in controversy needed by Medicare providers will change as follows: $170 for Administrative Law Judge (ALJ) hearings. (2019 – $160) $1,670 for judicial review (2019 – $1,630) The Center for Medicare and Medicaid Services (CMS) every year announces annual adjustments to the amount in controversy threshold

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07 Feb

Responding to Record Requests on a Timely Basis.

Health care providers are increasingly seeing request for records from all types of payors including but not limited Medicaid, Medicare and commercial insurance providers. The basis for receiving a requests for records could be as a result on any number of reasons, including compliance, aberrant billing practices or as a result of a ZPIC audit

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04 Mar

Hospital enters $85 million settlement for alleged Stark Law violations

Halifax Hospital agreed Monday, March 3, 2014, to settle a whistleblower case for alleged Stark Law violations with the U.S. Justice Department in the amount of $85 million — an amount so large it is more than twice the previous recors for hospital systems accused of Medicare fraud.  The Daytona Beach, Florida  hospital is accused of

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23 Aug

Gaitan Law Group Successfully Reduces a $736,305.93 Overpayment to $6,826.00

  CMS sought recovery of an alleged overpayment in excess of $730,000 from a diagnostic laboratory, upon the conclusion and recommendation of Safeguard Services (SGS) to deny all claims submitted for 3,006 Medicare beneficiaries.  Mr. Gaitan and Mr. Suarez, of our health care practice group, appealed the overpayment claim through the reconsideration (second level appeal),

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