Provider vindicated but wary

AMARILLO, Texas – Provider Josh Britten appealed $650,000 worth of denied Medicare claims back in 2015 and it took him six years and more than $100,000 to get it back. And he’s one of the lucky ones – he had the resources to stick with it. 

“We filed our third appeal in 2015 and we finally received a decision in 2021,” said Britten, CEO of BritKare Home Medical. “We were six years waiting on a decision (at the ALJ level) that should have taken 90 days.” 

Here’s what Britten had to say about why it should be a right, not a privilege, to be able to work the appeals process. 

HME News: How were you able to have that much money tied up for that long? 

Josh Britten: We’re pretty diversified. To be brutally honest, we’re not 100% DME based. We have a few pharmacies that helped to keep us afloat – had we not had those pharmacies, there’s no way we could have made it. Even though we made it, I still feel bad. A lot of our competitors in the industry aren’t able to stay afloat through something like this – and they’re good, legitimate companies. 

HME: Why were the claims denied? 

Britten: If you nitpick chart notes, you can find something. One claim was denied because the driver wrote in the wrong zip code – it was off a digit. They were little things like that. There was no smoking gun – it was basically the contractors being paid to find something. 

HME: Have you been operating any differently as result of the audit? 

Britten: We never stopped service. We never stopped doing what we knew was right for the community. What has changed is, patients are having to go home without oxygen or have their oxygen delayed for a period of time simply because physician groups aren’t qualified to get you the documentation up front. That’s the only thing these audits have changed. It’s the patient that suffers. 

HME: Did you try the Settlement Conference Facilitation? 

Britten: Yes, but I felt like they were just trying to get a deal out of me. I think the highest offer we got was 42%. We ended up with nearly 100%, so I’m glad we stuck to our guns. 

HME: The Office of Medicare Hearings and Appeals expects to work through the backlog at the ALJ sometime this summer – you must be pleased about that. 

Britten: It looks like we’re at end of this, but the scary issue looking forward is, as the managed care companies take over, there is no up or down on what they can and can’t do. At least with Medicare, there is a process in place. These MCOs – they could trample us.