Case Result: CMS Audit

Pain-Management Physician Practice.

Primary Issue:
Prepayment suspension of payments by third-party Medicare Authorized Contractor alleging a Gross and Flagrant Violation of the Standard of Care in a Substantial Number of Cases.

Benefit of Using Chapman Law Group:
Client was placed under a prepayment suspension of Medicare payments by a third-party MAC claiming Gross and Flagrant Violations of the Standard of Care in a Substantial Number of Cases of a pain-management physician. This resulted in Medicare denying payment for claims for over one (1) year. The MAC sought the permanent exclusion of the client’s Medicare license along with over three million dollars ($3,000,000.00) in penalties in fines. Chapman Law Group was able to appeal the decision to the Office of the Inspector General (“OIG”) and attack the MAC’s thirteen (13) areas of complaints regarding multiple patients.

Chapman Law Group was able to successfully negotiate with the OIG resulting in no fines being imposed against the client and a minimal exclusionary penalty from the threatened life-time ban. Chapman Law Group was also able to successfully appeal the prepayment suspension of payment showing the medical necessity of the patient encounter and procedures resulting in a payment of over one-hundred and seventy-thousand dollars ($170,000.00) to the client.

Area of Law:
Health care compliance
Medicare Appeals
Medical Standard of Care

This information is a sample of our past results. Prospective clients may not obtain the same or similar results. Every case is different and each case must be evaluated and handled on its own merits. The circumstances of your case may differ from the results provided. The information provided has not been reviewed or approved by the State Bar.

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