BCM Law Medicare Department Secures Three Favorable Results

June 2023

Surbhi Saraswat Goyal

The Social Security Act established five levels to the Medicare appeals process: redetermination, reconsideration, Administrative Law Judge hearing, Medicare Appeals Council review, and judicial review in U.S. District Court. The BCM Medicare team has been successfully navigating the complex and time-sensitive appeal process to gain significant reductions in conditional payments owed to Medicare.

The BCM Law Medicare team successfully re-opened a previously unfavorable conditional payment determination by the Commercial Repayment Center by locating a clerical error in the handling of the previous appeal. BCM Law argued that this constituted good cause for re-opening the case and then successfully challenged the claimed conditional payments of over $25,000.00.

Administrative Law Judge hearings have been backlogged for some time, requiring waits as long as 5 or more years before a hearing on the appeal. This prevented some clients from pursuing viable appeals due to the long waits. Well, there is good news. The appeals are moving faster. Recently, the BCM Law Medicare team secured a full refund of over $45,000.00 which was offset from the client by Department of Treasury based on the argument that the settlement contract and subsequent trial order found that respondent was not responsible for medical payments in the underlying workers compensation case. In another matter, the ALJ favorably decided the appeal on the merits of written appeal only. This resulted in over $20,000.00 in savings to the client.

Conditional payments, whether for liability, no fault, or workers compensation insurance, all follow the above appeal process, which has specific requirements and deadlines for filing. BCM Law urges our clients to critically and immediately review any correspondence from Medicare and contact one of our attorneys in our Medicare Compliance Practice Group if you need assistance.

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