Home Health Provider Sues Medicare Contractor and HHS Over Unfair Audit and Denied Medicare Reimbursement Payments

Friday, April 7, 2017
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On March 2, 2017, an Illinois home health care provider launched a class action law suit against Medicare reimbursement auditor AdvanceMed and the U.S. Department of Health and Human Services (HHS) Secretary Tom Price. MedPro Health Providers LLC (MedPro) filed the complaint in an effort to collect $300,000 it says it is owed in Medicare payments.  The complaint was filed in the U.S. District Court for the Northern District of Illinois.  The plaintiff, MedPro, which is a home health services provider, seeks status in the law suit as a class representative for all similarly situated health care providers.


The Complaint.

AdvanceMed is a Zone Program Integrity Contractor (ZPIC), which investigates suspected fraud, waste and abuse, according to the Centers for Medicare and Medicaid Services (CMS). Under the Medicare Act, CMS is allowed to enter into contracts with outside organizations to perform certain services, such as those of the ZPIC.

According to allegations made in the complaint, AdvanceMed contended that it found “reliable information” that MedPro had been overpaid for services and stopped reimbursements to the company. When MedPro provided a rebuttal statement to the findings, AdvanceMed allegedly ignored it.

According to the complaint, AdvanceMed's evaluation of MedPro was not fair. MedPro did not have the opportunity to show its own evidence that its operations were in order. MedPro expended significant resources and financial capital to prepare and transmit the response to AdvanceMed. When AdvanceMed finally responded to its rebuttal, its language was "basically boilerplate" and did not address MedPro's argument. MedPro said that new HHS Secretary Tom Price should take responsibility for AdvanceMed's failure to reply as a ZPIC auditor.

So far, MedPro's fraud allegation is only against AdvanceMed, not Price and HHS. However, in its complaint, it states, "The Secretary, through its ZPICs, has a plainly defined and nondiscretionary duty to properly and completely respond to MedPro’s Rebuttal Statement. MedPro has been irreparably injured because of the Secretary’s failure to carry out that duty."

To read the complaint in full, click here.

For more information on AdvanceMed and ZPIC Audits, click here and here to read two of my prior blogs. 

For a blog I wrote about a similar suit filed against Medicare contractors by the American Hospital  Association several years ago, click here.


The Health Law Firm Previously Filed Similar Suit in Michigan.

Prior to MedPro's class action suit, on September 1, 2016, New Vision Home Health Care, Inc., filed a similar suit in which The Health Law Firm now represents it.  It is New Vision Home Health Care, Inc., et al. v. Anthem, Inc. (f/k/a WellPoint, Inc.), TrustSolutions, LLC, and National Government Services, Inc., U.S. District Court for the Eastern District of Michigan, case number 2:16-cv-13173.  The New Vision suit did not seek class action status, but raised some of the same legal issues against CMS Medicare contractors.  To see a copy of the Second Amended Complaint filed in federal court, click here.


Don't Wait Until It's Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent health care providers in disputes with Medicare, insurance companies and complex litigation. Additionally, they represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.


Sources:

Miesel, Hanna. “Health Provider Sues Medicare Middleman For Reimbursements.” Law360. (March 2, 2017). Web.

Health Provider Sues Medicare Middleman For Reimbursements.”  LexisNexis. (March 2, 2017). Web.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


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4/7/2017

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