Medi-Cal and Medicare Suspension Appeals
Representing A Physician
Background: Medi-Cal had terminated a physician from the Medi-Cal Program on the grounds that he had been convicted of health care fraud related felony and misdemeanor conviction.
Resolution: After obtaining expungement of the criminal convictions and reinstatement by OIG, we filed a Petition for Reinstatement with the California Department of Health Services which was granted, and the physician was re-enrolled in the program. (2018)
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)
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. This result has been obtained numerous times over the years. (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)
Representing A Drug Rehabilitation Program
Background: Medi-Cal had placed a drug rehabilitation provider with multiple locations on temporary suspension and withhold on the grounds that it had failed to document services properly, billed for services not provided and other allegations of wrongdoing.
Resolution: After filing an appeal and meeting with the decision makers in Sacramento, the temporary suspension and withhold was lifted and a settlement agreement was entered into which alleged the provider to operate and saved its business. (2015)