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High Court ruling raises questions concerning ALJ appointments. A sneaky and under-publicized matter, which will affect every one of you reading this, slid into common law last year with a very recent case, dated Jan. 9, 2020, upholding and expanding the findings of a 2018 case, Lucia v. SEC, 138…
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The appellate court reversed the decision of the ALJ. When you defend an overpayment finding by a Recovery Audit Contractor (RAC) or a termination of a Medicare/Medicaid contract, you present before an administrative law judge (ALJ)in an administrative court. Today I want to write about the strength or deference that…
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Lack of auditor response leads to an ALJ hearing. “A stitch in time saves nine” is a pretty famous heuristic expression, but most people I know do not have any idea what it means. Simply stated, it means that taking the time to do something correctly now will save time…
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New case law supports due process for Medicare providers. Due process is one of the cornerstones of our society. Due process is the universal guarantee and found in the Fifth Amendment to the United States Constitution, which provides "No person shall…be deprived of life, liberty, or property, without due process…
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OMHA adds Chapter 14 to its case processing manual The Office of Medicare Hearings and Appeals (“OMHA”) has recently been updating its OMHA Case Processing Manual (“OCPM”). The OCPM was originally released in 2015 to regulate and codify procedures for adjudicative functions by using statutes, regulations, and OMHA directives as…
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OMHA Issues Updates to Its Case Processing Manual The Office of Medicare Hearings and Appeals (OMHA) announced updates to its OMHA Case Processing Manual (OCPM), which was first released in 2015. The purpose of the OCPM is to standardize and memorialize the day-to-day procedures for carrying out adjudicative functions in…
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OMHA also announced that the SCF expansion will include a “fast track” process, or “SCF Express.” The Office of Medicare Hearings and Appeals (OMHA) hosted a Medicare Learning Network (MLN) conference call to release details regarding the long-awaited expansion to the Settlement Conference Facilitation (SCF) program on May 22, 2018.…
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Low-Volume Appeals (LVA) and expansion of its Settlement Conference Facilitation (SCF) program are two new offerings by the Office of Medicare Hearings and Appeals (OMHA) to improve the appeal process. In an effort to improve the Medicare appeal process, hospitals are being offered two new programs – one designed for…
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CMS has accused Bryan Merrick, MD of wrongful Medicare billings on 10 patients over a span of 20 months. As they would react to a flood, ice storm, or fire, local officials and residents in the rural town of McKenzie, Tenn. are rolling up their sleeves and taking on a…
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When our son Zach was five, he asked about a case I was litigating against the government in Arizona.  “Are you on offense or defense?” he inquired. I explained that we were the plaintiffs, which meant we were “on offense.” Zach looked pensive before he declared “I think that when…
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