On December 13, 2018, a Medicare administrative contractor revoked an ambulance provider’s Medicare billing privileges based upon an innocent error. The initial determination involved a retroactive revocation going back over 7 years and a 3 year prospective enrollment bar. This determination mandated the provider not only return to CMS all Medicare payments received during the 7 year retroactive revocation, it also prohibited the provider from treating Medicare patients for an additional 3 year period.

Nelson Hardiman appealed this decision. As a result of this initial appeal, CMS overturned the retroactive enrollment bar, resulting in a significant victory for our client. However, because CMS affirmed the 3 year prospective enrollment bar, our client was facing financial ruin. Therefore, Nelson Hardiman further appealed the prospective enrollment bar. Following submission of Nelson Hardiman’s appeal, CMS reconsidered its position and reduced the 3 year enrollment bar to a mere 14 months! This was an astounding victory which allowed our client to continue to provide medically necessary ambulance services to the residents of Los Angeles.

If you believe CMS has wrongfully terminated your Medicare participation, Nelson Hardiman may be able to help you.

For more information, contact:

Regina Trainor