Chapman and Mitchell obtain remand for reconsideration in Medicare appeal
In November 2020, a Mississippi federal court judge ordered the secretary of the U.S. Department of Health and Human Services to reconsider new material evidence submitted by HAT attorneys Philip Chapman and Julie Mitchell. The Secretary of HHS alleged that a family practice clinic represented by HAT was overpaid for urine drug screenings provided to Medicare beneficiaries receiving regular opioid prescriptions for pain management.
The family practice clinic was audited by a Medicare Zone Program Integrity Contractor in 2014 and initially alleged an overpayment of $19,561.63. This claim brought the clinic’s total demand for reimbursement to $4,655,794.47. After finding success at various levels of administrative appeal, the total amount of alleged overpayment was decreased to $14,797.43 actual or approximately $3,000,000.00 extrapolated.
The remaining claims were then appealed to the Mississippi federal court, where HAT attorneys introduced new evidence reflecting the current understanding of the nation’s opioid crisis. Evidence included a report from the Mississippi Governor’s Opioid and Heroin Study Task Force, which included guidance on the reasonableness and necessity of the services underlying many of the disputed claims. In September 2020, Judge Keith Starrett issued an order remanding the case back to HHS for reconsideration.
In November 2020, the HHS secretary filed a motion for reconsideration, alleging the new evidence was neither new nor material to the claims at issue in the case. Judge Starrett denied the secretary’s motion, stating that HHS failed to provide additional evidence of overpayment and no explanation as to why HHS was arguing select claims. Judge Keith Starrett issued an order remanding the case back to the secretary of HHS for reconsideration and issued the case as administratively closed until HHS could provide additional and modified evidence of overpayment.