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June 2015 Archives

Federal Court Rules in Favor of Teladoc, Blocks TMB and Preserves Telehealth in TX

The Texas Medical Board has been attempting to limit competition in Texas by requiring face-to-face visits between physicians and patients prior to the physician being allowed to prescribe medicine. Teladoc has asserted that this is a violation of federal law including the Sherman Antitrust Act which has been around for more than 100 years protecting free-market business. Judge Robert Pitman for the U.S. District Court of the Western District of Texas has blocked a recent action by the Texas Medical Board that would limit telehealth in Texas. Teladoc has been operating in Texas for over ten years and this ruling stated that the Texas Medical Board failed to produce evidence to support that telehealth poses a patient safety risk or that any harm has been done by the practice of telehealth.

Medicare Overpayment Extrapolations and How to Vastly Reduce Them

In a recent case Rivas Goldstein, LLP was able to significantly reduce a Medicare Overpayment for one of our clients. The client was faced with an initial recoupment of $5,459,933.90. This was based on Medicare's claims that they had performed a "computer generated statistically valid random sample of claims." The sample of claims that they referred to came from over a two year period with a total of 2,189 claims. From these claims they took a sample of 48 claims and, based on their statistical analysis of these claims, found errors and extrapolated them to come up with their final overpayment number due. Through the diligent work of the Rivas Goldstein team, we were able to receive a fully favorable decision on our argument that the extrapolation was invalid. This in turn altered the overpayment amount to only reflect the actual 48 claims that Medicare reviewed. At this point, the overpayment has been reduced from $5,459,933.90 all the way down to only $122,470.52. This was accomplished solely from the arguments we crafted to invalidate their extrapolation methods.

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