What Should I Do if I Have Been Excluded as a Medicare Provider?

 Posted on November 16,2022 in Medical License Defense

Accusations of Medicare fraud or abuse can have a significant impact on a healthcare provider’s ability to practice his or her profession. In addition to limiting the kinds of patients a provider can serve, Medicare provider revocation can be involved without other sanctions that may prevent a doctor from practicing altogether and may involve hefty fines. In one recent example, a Kentucky doctor was fined $720,000 and suspended from federal healthcare programs for fifteen years for submitting false claims to Medicare and Violating the False Claims Act.

If you are facing accusations of Medicare fraud, you need experienced, aggressive legal counsel to help you manage the investigation in your favor. If you have already had your Medicare provider status revoked or suspended, a professional license defense attorney may be able to help you get your privileges back.

Why Would Medicare Provider Status Be Revoked or Suspended?

Because Medicare is a government program and the government relies on trustworthy practitioners to provide excellent medical care to potentially vulnerable patients, investigators with the Centers for Medicare and Medicaid Services (CMS) are motivated to find and investigate those who may be acting in ways that are not conducive to Medicare’s overall aims. A healthcare provider may face suspension, permanent revocation, or a reenrollment bar for many reasons, including:

• Providing false or misleading information to Medicare
• Failing to report sanctions to a practitioner’s medical license
• Billing from noncompliant locations and other billing abuses
• Inappropriate or illegal provider conduct that harms patients
• Felony convictions, including financial crimes and crimes against persons, such as murder, rape, or assault
• Affiliations with Medicare sanctioned suppliers or other affiliates
• Improper prescribing practices

Can I Appeal a Medicare Provider Status Revocation?

If your Medicare provider status is revoked or otherwise sanctioned, you do have the right to appeal in certain circumstances, including:

• Terminating a relationship with a managing employee or owner whose revocable offense caused the provider’s own revocation
• Filing a Corrective Action Plan (CAP) for reasons of non-compliance within 30 days of revocation notice
• Reconsideration requests to CMS asking them to consider mitigating circumstances
• Administrative Law Judge hearings for questions of CMS’s authority
• Departmental Appeals Board (DAB) hearings
• Federal judicial review

An experienced professional license defense attorney can help you determine whether any of these strategies will be helpful in your case.

Call an Illinois Professional License Defense Lawyer

Problems with your Medicare provider status can become very complicated and have a major impact on your ability to work and provide the kind of healthcare your patients deserve. To defend against accusations of Medicare abuse or to learn more about getting your Medicare provider status re-implemented, call an Illinois professional license defense attorney with The Law Offices of Joseph J. Bogdan, Inc. at 630-310-1267.

Sources: 

https://www.justice.gov/usao-wdky/pr/doctor-pays-720000-and-agrees-15-year-exclusion-federal-health-care-programs-violating

https://www.law.cornell.edu/cfr/text/42/424.535

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf