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Medicare Fight: The Time Is Now!
By Keith Crownover, BS, CPO, BOCPO For those who are truly serious about holding CMS
and specifically Region C accountable for their actions and
inactions, now is the time!
We have located an attorney who specializes in healthcare law.
He is currently researching the feasibility of filing a class
action suit against the Centers for Medicare & Medicaid
Services (CMS) Region C (Palmetto) Durable Medical Equipment
Regional Carrier (DMERC). In order to determine whether a class
action suit can be certified and initiated, we need all individuals
who desire involvement and have credible evidence of wrongdoing to
come forward ASAP!
If you as a practitioner and/or your practice has suffered
delayed payments, repeated denials, or any other type of tangible
fiscal damage in the pursuit of providing care for Medicare
recipients, we would like to hear from you. These accusations must
be accompanied by properly submitted, legitimate, correctly filed
documentation (please do not send any claims or patient documents).
However, if you believe your claims have been delayed, denied, or
rejected due to constant vacillation of CMS policy and procedures,
and you can demonstrate a pattern of such, this too may be a cause
of action.
We are in need of as many complainants as possible who have
tangible, factual proof of CMS Region C's violations. We need
specific examples of inappropriate behaviors, types of claims,
L-Codes delayed and/or rejected, numbers of claims filed with a
particular code or claim rejected and/or delayed, percentages of
problem claims and/codes, numbers of denials and/ or delays,
quantified over specific segments of time (within the past six
months, 12 months, etc.).
Feel free to submit any further problematic areas regarding
consistent problems in Medicare reimbursement you or your practice
has suffered. Please remember HIPAA regulations and do not submit
any personal information. Problems, time frames, number, dollar
amounts lost in denials and/ or appeals and percentages of
problematic (denied, rejected, delayed past 90 days, etc.) claims
will suffice at this point.
Once our evidence is collected and presented to the firm, it
will determine if we can and should proceed with a class action, an
individually filed suit, or if the firm will decline
representation. Obviously a law firm will not accept a case on
contingency unless it sees a substantial chance to win and/or
publicity likely to produce revenue. If we offer a retainer, then
collective damages can be a smaller sum, and the firm will accept
the case. From what we have experienced and from speaking with a
number of our colleagues, I see no reason why we cannot all join
together, provide indisputable evidence of egregious acts numbering
at least in the hundreds of thousands of dollars, and together hold
CMS and specifically Region C responsible for what they have
done!
We certainly are very aware that seeing actual monies is a
distant reality, if one at all. But we must try; we must be heard!
If the final outcome produces changes that benefit recipients as
well as providers, then it will be worthwhile. I firmly believe
that there is a real civil case here and that initiating it may
bring about investigations showing breach of federal law. With or
without my colleagues, my resolve shall remain intact. However,
there is strength in numbers, and every provider that has been
damaged should be fairly compensated, and justice should be done
for all of us!
In order to be involved in this action, we must be notified, and
information must be forwarded to me by September 30. Please e-mail:
OkLpo1@aol.com;
fax: 405.621.9986, or send to: Advanced Orthotic Prosthetic
Technologies, 5601 NW 72nd #308, Oklahoma City, OK 73132 all the
above outlined factual evidence.
Keith Crownover, BS, CPO, BOCPO, LPO, is co-owner and
clinical directorof Advanced Orthotic Prosthetic
Technologies LLC, Oklahoma City, Oklahoma. He is a member of the
Board of Directors of the Board for Orthotist/Prosthetist Certifi
cation (BOC), a past chair of Oklahomas Prosthetist and Orthotist
State Licensing Advisory Committee and past executive treasurer,
International Association of Orthotics and Prosthetics
(IAOP). 
Table Of Contents - September 2005
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