By: Matt Fischer
Fighting a large extrapolated overpayment demand from a Medicare Administrative Contractor (MAC)? Facing bankruptcy? Appealed to the Office of Medicare Hearing and Appeals (OMHA) with no hearing date in sight? For providers and business owners who answer yes, there is a new potential remedy…a temporary injunction.
Multiple health care businesses have scored wins this year in their fight to prevent CMS from recouping payments before having an opportunity for an Administrative Law Judge (ALJ) hearing. The similarity? They each sought a temporary injunction in federal court. Arguing that the alleged recoupments would cause the businesses to close, employees to lose their jobs and patients would be forced to change their providers, the businesses were granted temporary injunctions enjoining CMS from starting recoupment until the ALJ appeal stage had reached a conclusion.
The current backlog wait time is currently 3 to 5 years. These court decisions are significant as it gives providers and suppliers a potential new avenue for temporary relief when CMS takes action first, offers post decision appeals, and forces providers to wait for years before deciding an appeal or even scheduling a hearing. In other words, it offers a targeted remedy to stall recovery of disputed claims before a provider or supplier can have a hearing. It should be emphasized that these cases did not challenge CMS’ power to recover overpayments or the merits of an alleged overpayment. Here, the injunctions were granted for the limited purpose of suspending recoupment before a hearing can be held and not to prohibit recoupment altogether.