Health Care: Medi-Cal and Medicare Suspension Appeals

REPRESENTING A PHYSICIAN

Background: Medi-Cal denied a physician’s continued enrollment in the program on the grounds that he had been placed on probation by the Medical Board.
Resolution: We filed an appeal with the California Department of Health Services which was granted, and the physician was re-enrolled in the program. (2007) (2005)

Background: Medi-Cal issued a temporary suspension and temporary withholding of payment on the grounds of a physician’s alleged fraud and abuse.
Resolution: We filed an appeal with extensive supporting documentation. The Department of Health Services lifted the suspension and withholding. (2004) (2007) (2005)

Background: Medi-Cal issued a temporary suspension to a physician on the grounds of alleged fraud and abuse.
Resolution: We filed an appeal and entered into negotiations with the Department of Health Care Services. The temporary suspension was lifted. (2008)

Background: The Office of Inspector General issued a five-year Medicare exclusion to a physician on the grounds that he was convicted of a criminal offense.
Resolution: We filed an appeal showing that the offense was not an excludable misdemeanor, and exclusion was lifted. (2006)