It's serious, alright

 - 
Monday, July 1, 2019

Have you read the article “New ‘serious’ decision on recoupments” in March 2019 issue?

It is “Serious” because every DME provider knows the reviews and hearing processes provided by Medicare Law (ML) and, therefore, knows that the government, CMS and Congress, have violated all reimbursement rights by their legalization and enforcement of the recoupment protocol called Extrapolation Review. 

How does the Extrapolation Review protocol violate ML?  By only two reviews by CMS over a few post-audit reviews over a five year period they can and have extrapolated the results over all the claims in that same period and demand immediate recoupment without a first or second review by CMS or by a totally independent Administrative Law Judge (ALJ) not under CMS control to adjudicate the providers Constitutional Rights as spelled out by ML.

You have been reading in HME news that 80% of ALJ hearings have reversed the unfavorable CMS determinations.  Why do you think this is possible?  I can think of none other than CMS reviews are preempted by their constant adoption of new rules and regulations in the past 10 years by which clerical errors carry as much weight as Medical Necessity (MN) to determine recoupment where ML makes payment based on MN by which the ALJs adjudicate.

How is it possible to have ALJ hearings backed up for 5 to 8 years and for Congress to have been unable to correct the situation and the injustice this causes which has put DME businesses out of business before a fair and impartial review and hearing when your claims are prejudged by Extrapolation Review protocols which are simply legalized protocols circumventing ML protecting constitutional rights.

CMS created the ALJ back log and also the rules of recoupment even to being the perpetrator and the only one legally who can recommend mitigation or any consideration of injustice to be sent to the Department of Justice (DOJ).  Any request directly to the DOJ is sent back to CMS for their approval.

Our only recourse in fighting CMS and Congress over government encroachment is a Class Action Lawsuit.  That is serious business and it must be done and hopefully there is enough Justice and Truth in our courts to have it adjudicated since it required the DOJ to approve the legalization of the Extrapolation Review protocols circumventing ML which protects the Constitutional rights of the provider. In all this the patients and their doctors know nothing about the injustice denying claims they expected to be paid, unless, it is brought to light by a class action lawsuit and into the hands of the public whom government is supposed to represent and just laws are to protect.

  Frank M. Demock, President/Owner

Wheelchair & Walker Rentals