Louisiana medical practice sues to stop CMS from withholding Medicare payments

Michael Dole, MD, the president and sole shareholder of a medical practice in Alexandria, La., has filed a federal lawsuit against HHS and CMS seeking to stop CMS from withholding Medicare payments from the medical practice after a billing audit, according to the Louisiana Record.

Here are four things to know:

1. Zone program integrity contractors are private companies that contract with CMS to investigate instances of suspected fraud, waste and abuse, and to identify any improper payments that are to be recouped by Medicare administrative contractors.

2. At issue in the lawsuit filed by Dr. Dole are two post-payment reviews performed by AdvanceMed, a ZPIC. According to the lawsuit, AdvanceMed determined Medicare overpaid the medical practice by $9,268 in the first post-payment review. In a second review, the ZPIC determined that $10,466 in claims were overpaid to Dr. Dole's practice, and that amount was extrapolated to $4.34 million.

3. The medical practice is seeking a preliminary and permanent injunction preventing CMS from withholding Medicare payments from the practice for ongoing services after the audits. The medical practice asks the court to stop CMS from collecting "any more of the … alleged overpayment amounts … until it has been afforded a meaningful opportunity to exhaust all administrative remedies."

4. The medical practice said it filed a timely appeal of AdvanceMed's determination, and it is asking the court to require HHS and CMS to provide it a hearing before an administrative law judge.

Access the full Louisiana Record article here.

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