Case Studies

It’s a typical Wednesday morning at your DMEPOS storefront location. All of a sudden, two men enter your store and identify themselves as agents of Office of Inspector General (OIG). They hand you a... Read more >
Within the last year, I have seen a significant increase in the number of insurance carriers (“insurers”) that perform pre-payment and post-payment audits on providers’ claims. Moreover, many of... Read more >
There has been a recent increase in the number of lawsuits brought by health care workers against employers under the Fair Labor Standards Act (FLSA). This article provides a summary of the FLSA and... Read more >
Nancy J. Griswold, Chief Administrative Law Judge at the Office of Medicare Hearings and Appeals (OMHA), sent a memorandum to various providers warning that, effective July 15, 2013, Administrative... Read more >
Three weeks ago, when I was asked to advise a client on how to apply for an Extended Repayment Plan, I turned to the Medicare Financial Management Manual (MFMM), expecting the same answer as recent... Read more >
Even though the Medicare DMEPOS Competitive Bidding Program only allows contract suppliers to supply competitively-bid items in particular areas, non-contract suppliers in these areas are not so... Read more >
For years I have advocated the use of attestations and addendums when supplementing documentation responses to Medicare audits. In fact, I still have the Administrative Law Judge’s (ALJ)... Read more >
As a lawyer who has helped dozens of providers with audits, at some point in the appeals process every client asks me: “can’t we just sue the auditor?” Even though auditors... Read more >
An Accountable Care Organization (ACO) can be comprised of any number of acute and post-acute providers, including physicians, hospitals, home health agencies, DMEs, etc., (called “... Read more >
During an audit appeal, the majority of improperly denied claims are overturned, if at all, at the Administrative Law Judge (ALJ) level. This is because ALJs are able to apply rationality and... Read more >