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Durable Medical Equipment (DME) audits and enrollment revocations from the Centers for Medicare & Medicaid Services (CMS) and its contractors, like CoventBridge, Qlarant, Noridian, Palmetto, and Novitas, can threaten the stability of your DME business, impacting both your operations and finances. At Health Law Alliance, we specialize in defending DME suppliers against aggressive government oversight, helping you fight overpayment demands, enrollment revocations, and other penalties.
Do not wait until your rights are lost. With experienced legal guidance, your business can navigate these challenges with confidence, protecting your billing privileges and safeguarding your business. The earlier we are involved, the better chance you have to prevent these severe consequences. Call now for immediate assistance.
Comprehensive Audit Preparation: We review your practices to identify and resolve potential compliance risks.
Effective Documentation Support: Ensure all records and procedures meet DME licensing standards, minimizing risk during billing audits or enrollment revocation proceedings.
Proactive Defense Strategies: Rely on a defense strategy tailored to protect against recoupment demands and unfounded allegations.
Ongoing Compliance Guidance: Stay informed about the latest DME supplier requirements and regulatory updates to prevent future audit or revocation issues.
Appeals and Legal Representation: Our team represents you throughout the process, from the initial notice to administrative appeals, including dispute resolution if necessary.
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Former Government Regulators on Your Side – Our team of healthcare defense specialists is spearheaded by former federal and state prosecutors who understand how the government and its contractors use data mining and proprietary algorithms to identify potential Fraud, Waste & Abuse (FWA) for audits and investigation. Because we understand how the government builds cases, we use their playbook to beat them.
Healthcare Specialty Attorneys and Consultants – Health Law Alliance specializes in healthcare law and is dedicated to defending providers and their licenses from overreach. Our founding partner previously served as a top executive for the biggest companies in healthcare, including McKesson, Relay Health, CoverMyMeds, United Health Group, Optum, and United Healthcare. We know the tricks insurance companies use to deny claims, and use that inside information against them.
Proven Track Record – Some clients turn to us when stakes are the highest, when their businesses are threatened, when their license is challenged, and when their options are limited. Our wins against the government and insurance companies can be reviewed HERE. Many more clients, however, turn to us at the first sign of potential trouble, when we can neutralize the problem before it grows. Either way, we have your back from beginning to end.
Frequently Asked Questions about DME Audit & Enrollment Revocation
What causes a Medicare overpayment demand, and how can it impact my company?
A Medicare overpayment demand typically results from billing errors, a lack of documentation to prove medical necessity, or failing to meet a technical requirement for a claim. The most immediate impact is financial, as Medicare will demand repayment and can place your company on a 100% prepayment review or withhold future payments to recoup the debt. Left unaddressed, large or repeated overpayments can also put your billing privileges at risk.
What causes a Medicare enrollment and billing privilege revocation, and how does that impact my company?
A revocation of your Medicare billing privileges is the most severe penalty a provider can face. It can be triggered by unresolved overpayments, failing to comply with regulations, application integrity issues, or other serious infractions. The risks are catastrophic and include a complete halt of all Medicare payments, a re-enrollment bar that can last for years, and placement on a preclusion list that prevents you from contracting with many other payors.
How can you help me fight a Medicare revocation notice?
Responding to a revocation notice requires an immediate and strategic defense. We help you assemble a Corrective Action Plan (CAP) to show Medicare how you have fixed the underlying problems. We also represent you in the formal appeals process to fight the revocation itself. Our objective is to demonstrate your compliance and protect your ability to continue operating as a Medicare provider.
Is it possible to appeal a Medicare revocation?
Yes, a Medicare enrollment revocation or billing privilege revocation can be appealed. Successfully appealing a revocation is challenging and requires proving that Medicare’s determination was incorrect or that you have fully corrected the issues that led to it. Unlike a simple monetary dispute, a revocation appeal is about defending your company’s fundamental ability to do business, making experienced guidance essential.
If I disagree with a Medicare overpayment demand, what are my options?
You have the right to challenge the demand through a formal, multi-level appeals process. The key is to act quickly within the strict deadlines and submit a strong case supported by medical records, physician orders, and proof of delivery. We can help you navigate each level of appeal, from the initial redetermination to a hearing before an Administrative Law Judge, with the goal of overturning the inaccurate finding.
How can I make my company better prepared to prevent future Medicare overpayments or enrollment revocations?
Start by building a strong compliance foundation: conduct regular internal audits, train staff on documentation standards, and keep current with Medicare and regulatory changes. We offer compliance consultations to help you identify any risk areas and improve your documentation practices, reducing audit stress and keeping your company well-prepared. This proactive approach can give you peace of mind and lower the chances of unexpected overpayment demands.
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