(July 19, 2012): Choosing the right ZPIC audit appeals attorney to represent your practice is possibly the most important step you can take to protecting your rights during the ZPIC audit and appeals process. Indeed, who your representative is in ZPIC cases can make all the difference in the world. It is not enough to choose an attorney who is experienced. Instead, you should consider retaining an attorney who is experienced in this specific area of the law, and has the proven skills, talent, and expertise it takes to successfully argue for coverage and payment.
While many attorneys and consultants may say that they are experts in this area, have they been before Administrative Law Judges (ALJs) in all 4 of the Office for Medicare Hearings and Appeals (OMHA) field offices? Do they consistently file appeals or defend against appeals filed with the Medicare Appeals Council? Do they know the Medicare appeals process forward and back, and the nuances and expected outcome of each? These are just some things to keep in mind when asking an attorney whether they are really the right fit for you and your practice.
I. How Can a ZPIC Audit Appeals Attorney Help With Your Case?
Unfortunately, many ZPIC audit appeals end up as “bet-the-farm” litigation, meaning that either the provider wins, and stays in business, or if the provider loses, the alleged overpayment found by the ZPIC is so huge that they are forced to shut their business down. As part of this, you should ensure that your attorney is comfortable with understanding and arguing against complex statistical extrapolations, which ZPICs use to greatly increase the alleged overpayment in most cases. Also be sure to ask your attorney whether they consistently work with statistical consultants who are recognized experts in their field, and consistently qualify as experts before ALJs.
II. Final Remarks:
Finally, make sure that you choose an attorney who is well-versed in the variety of legal arguments that providers often rely upon to reduce or eliminate their overpayment liability. There are a number of statutory waivers, as well as due process considerations, that can be critical to convincing a judge or the Medicare Appeals Council that you should not have to pay an overpayment. Only a ZPIC audit appeals attorney with a significant degree of know-how in this regard will be in an appropriate position to advise you about these options.
Again, think carefully when retaining a ZPIC audit appeals attorney – it can be the biggest decision you make.
Robert Liles represents providers in Medicare post-payment audits and appeals, and similar appeals under Medicaid. In addition, Robert counsels clients on regulatory compliance issues, performs GAP analyses and internal reviews, and trains healthcare professionals on various legal issues. For a free consultation, call Robert today at 1 (800) 475-1906.