A Michigan Durable Medical Equipment (“DME”) company received a letter from a Medicare contractor that its Medicare supplier number had been revoked, because it failed to comply with supplier standards. The letter also stated that, pursuant to 42 C.F.R. § 424.535(c), the DME company’s Medicare supplier number was not able to be reinstated for 2 years.
To assist with their Medicare provider appeal, the DME company retained our specialized healthcare compliance team, as the contractor letter stated that a corrective action plan could be submitted within 35 day and request for reconsideration could be submitted within 65 days.
Corrective Action Plan (“CAP”):
Along with the detailed CAP and Medicare provider appeal, Senior Attorney Juan C. Santos was retained to conduct a compliance assessment and for the implementation of a new compliance program.
He initiated an in-depth session to discuss pertinent health care laws and regulations, educating the team on health care compliance. While presenting this, he also covered how to protect the company from government audits and investigations, as well as against potential civil or criminal penalties.
Accompanying new policies and procedures and code of conduct, Juan Santos will be providing quarterly compliance training to the DME healthcare providers team. This will allow them to remain up to date on the ever-changing health care industry.
Request for Reconsideration:
Beginning with 42 C.F.R. § 424.57(c)(11), Juan Santos provided affidavits from 5 of the beneficiaries stating that they did not receive unsolicited communications from the DME company, and that the physician-ordered items were medically necessary.
The DME company was able to provide documentation of the specific billing codes used to place orders for diabetic shoes, which, in turn, did not violate 42 C.F.R. § 424.57(c)(12). Juan Santos was able to demonstrate that our client did not falsely advertise that it would supply custom diabetic shoes.
The final allegations, 42 C.F.R. § 424.57(c)(21) and (26), were in reference to operating without an active surety bond. Juan Santos was able to provide the CMS contractor with the active surety bond paperwork, which our client did admit he mistakenly failed to send to CMS. Having the proper documents, however, proved that the DME company was never functioning without coverage.
Within just 30 days, the Medicare contractor confirmed their review and approval of the CAP that Juan Santos submitted on behalf of the DME company. The contractor indicated that it approved the CAP Juan Santos submitted on behalf of the DME company, meaning that the initial determination revoking the Medicare supplier number was overturned. This swift action overturned the initial determination revoking the DME company’s Medicare supplier number, enabling our client to resume serving patients without delay.
Areas of Law:
Medicare and Medicaid Compliance
OIG & State Exclusions
Developing an Effective Healthcare Compliance Program
Juan C. Santos
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.