Lecture:

Presented By:

   

 "How to Avoid the Revocation of Medicare Billing Privileges"

Alexander W. Kirkpatrick, Attorney at Law
Fenton Law Group, LLP

Alexander Kirkpatrick is a healthcare lawyer with Fenton Law Group LLP. He has been engaged in healthcare law since 1978 when as a deputy attorney general in the California Department of Justice in the Criminal Law Division, he was invited to join a newly-formed team of attorneys prosecuting Medi-Cal fraud charges against a broad range of providers. Alex resigned from the Attorney General’s Office in 1983 to enter private practice in Pasadena. After working with several law firms and as a sole practitioner, he joined Fenton Law Group as “Of Counsel” in 2017.

Alex’s practice focuses on several closely-related fields of practice: reimbursement, including enrollment issues and sanctions imposed by Medicare and Medi-Cal, such as revocations, audits, exclusions, suspensions and fraud and abuse allegations affecting providers in medicine, pharmacy, psychology, and other fields; professional disciplinary matters representing licensees before the Medical Board of California and other professional licensing boards; writs and appeals; and civil litigation on behalf of licensees in contractual and reimbursement-related disputes.

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In the practice of medicine, pragmatically, most physicians are enrolled providers of service under the Medicare program. Medicare enrollment is generally required for membership on preferred provider panels of Health Plans such as Aetna and Anthem Blue Cross; Medicare eligibility is invariably required for physician membership on the medical staff of acute care hospitals, skilled nursing facilities, rehabilitation facilities, and is also typically required for membership in an Independent Practice Association or “IPA.” This presentation focuses on problems that individual physicians and physicians engaged in group practices such as an IPA may encounter. Noridian Healthcare Services, LLC, the local Medicare contractor, has very broad authority to terminate or revoke a Medicare provider’s billing privileges. A revocation may last for up to three years; appeals are often denied. In many cases, the pragmatic effect of Medicare debarment is to effectively put the physician out of practice for a period of years. Frequently encountered grounds for revocation of Medicare billing privileges will be discussed. Many of these pitfalls and grounds for revocation can be avoided through careful preparation of enrollment and re-enrollment documentation and close supervision of the billing process to avoid erroneous or incorrect charges being submitted to Medicare.

Location:

Empress Harbor Seafood Restaurant
111 N. Atlantic Blvd. #350
Monterey Park, CA 91754
(626) 300-8833

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