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 to the actual dollar amount billed per claim. It is important to note that the Firm’s success was predicated on prevailing on a sufficient number of favorable claims resulting in the removal of the extrapolated overpayment. Thus, our clients multi-million dollar extrapolated overpayments were reduced to mere fraction of what was originally identified by the UPICs and MAC demand letters. In one example, the extrapolated overpayment of approximately $4.7 million dollars charged against a hospice provider was reduced to approximately $80,000.00.
Mr. Rafael (Ralph) Gaitan has developed through his many years in practice, a strategy that is specifically tailored to the client’s needs associated with legal expenses, business cash flows, and maintaining operations during the various appeals required to successfully challenge CMS overpayments, especially extrapolated overpayments. Thus, if you are a provider that has been notified by a UPIC (Qlarant, SafeGuard Services, Covenantbridge, etc) of an audit resulting in an extrapolated overpayment, you should contact an experienced healthcare attorney who handles administrative challenges and appeals with the various CMS contractors and before administrative law judges.
Although Mr. Gaitan has had success in challenging overpayments, it should be noted that Mr. Gaitan’s success was in part of collaborative effort between the attorney and the client as well as the availability of medical records.
If you are a provider who needs assistance or information regarding medical records requests, audits, or demand letters from CMS contractors, kindly contact Mr. Gaitan at (786) 440-8115 or via email at [email protected]. Mr. Gaitan would be happy to assist and provide you a road map and approximate time frames associated with these types of matters as well as flexible fee arrangements.