Indiana Attorney Helping Doctors Defend Against Loss of Provider Status

Lawyer Assisting Medical Professionals With CMS Audits and Issues Affecting Enrollment in Medicare/Medicaid Programs

Doctors, pharmacies, and other medical providers need to be able to work with insurers to ensure that they can receive payment for the services provided to patients. Many patients in the United States are covered by Medicare or Medicaid, and to provide treatment to these patients, medical professionals will need to maintain enrollment in these programs. There are a variety of ongoing requirements that providers will need to meet to ensure that they can continue providing services through Medicare and Medicaid, and if they fail to meet these requirements, or if they are accused of committing certain types of violations, they could potentially lose their provider status. Because this can have a significant effect on a provider's ability to maintain a steady income and properly bill patients for their services, it is crucial to address the potential loss of provider status quickly and effectively.

At the Law Offices of Joseph J. Bogdan, LLC, we have a strong understanding of the laws and regulations that apply to medical professionals, as well as the procedures followed by government agencies that investigate alleged violations. We can help providers determine the best steps to take during audits and investigations, and we can work with them to demonstrate that they meet the requirements that will allow them to maintain enrollment in Medicare/Medicaid. We can also assist with related issues, including discipline to a medical license or pharmacy license or defense of a provider's DEA controlled substance registration.

CMS Audits and Investigations That May Affect Provider Status

Audits are regularly performed by the Centers for Medicare & Medicaid Services (CMS), and auditors will be looking to ensure that a provider has complied with all enrollment requirements, including paying required fees, maintaining proper records, and following all standards that apply to medical professionals. Issues uncovered during an audit or other forms of discipline against a provider may lead to the revocation of provider status. These issues may include:

• Fraudulent billing practices - Medicare fraud is an ongoing concern in the United States, and CMS will be looking to identify any instances in which a provider may have billed Medicare or Medicaid incorrectly. Fraudulent claims can take a variety of forms, including billing for services that were unnecessary, using improper billing codes to increase the amount of payments received for services, or billing for services or supplies that were not actually provided to patients. However, even if a provider did not intentionally commit fraud, they may face penalties due to errors made in claims, inaccurate records of services provided, or other failures to follow their requirements when submitting bills to Medicare or Medicaid.
• Unethical or unprofessional conduct - If a medical professional is subject to disciplinary action that results in the suspension or revocation of their medical license, this may also result in the loss of their Medicare/Medicaid enrollment. Accusations of malpractice, sexual misconduct, failure to follow the standards of care, false advertising, or other unethical practices may affect a provider's ability to continue providing services to patients.
• Mishandling of controlled substances - Doctors or other professionals who prescribe medications or pharmacists who dispense prescriptions may be accused of engaging in drug diversion or drug trafficking. If the Drug Enforcement Administration (DEA) takes action to suspend a provider's controlled substance registration or pursues criminal charges related to the illegal use of drugs, this may result in the revocation of Medicare/Medicaid provider status.
• Criminal convictions - Certain types of felony offenses are considered to be detrimental to the best interests of the Medicare and Medicaid programs and patients. If a provider is convicted of these crimes, their provider status may be revoked. Applicable offenses include violent crimes such as murder or assault, financial crimes such as insurance fraud or tax evasion, or criminal neglect related to a medical malpractice lawsuit.

Contact Our Indiana Medicare/Medicaid Enrollment Defense Lawyer

Our firm helps medical professionals address multiple issues that may affect their ability to continue providing services to patients. We can work with you to defend your provider status, your medical license, and your DEA registration. To get legal help with these issues, contact us at 463-219-2612 to arrange a complimentary consultation.