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What you should know about Medicare overpayment appeals

If you receive a letter from the Health Integrity or Office of Inspector General in Texas regarding the overpayment of Medicare claims from your practice, you may wonder what you can do to avoid penalties. Even though you may feel embarrassed, confused or worried about the situation, it is important you make your specific circumstances top priority.

Keep in mind that you must submit repayment within a timely manner. If you procrastinate or overlook sending the payment in, you could end up facing False Claims Act penalties, such as additional fines, criminal charges and imprisonment. If you feel there is an error and there was no overpayment or the amount on the letter is not accurate, you can file an appeal. Here is a brief overview of the Medicare appeals process.

Appealing an inaccurate overpayment issue

If you act fast enough, you can submit a rebuttal explaining why you believe the demand for overpayment is not true. You should be prepared to submit any supplementary documentation to support your Medicare overpayment appeal. A Medicare administrative contractor will review the evidence to determine if there is still an overpayment issue. A qualified independent contractor will do a reconsideration. If after the reconsideration you still feel there is a mistake, you may submit an appeal for review by an Administrative Judge. The next step for appeal if you still do not agree with the decision is the Medicare Appeals Court (MAC). Depending on the outcome, you may qualify to appeal the MAC’s decision in federal court.

Appealing a Medicare overpayment issue is a time-sensitive process. It can be easy for you to feel intimidated and confused about how to proceed to avoid complications and penalties that can impact your ability to receive Medicare payments in the future. Many healthcare providers find it beneficial to seek out guidance from their attorneys.