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July 31, 2020

Barclay Damon's Pharmacy Team Reverses Revocation of Medicare Billing Privileges for DME Supplier

Barclay Damon attorneys successfully staved off a revocation of a durable medical equipment (DME) supplier’s Medicare billing number by a Medicare administrative contractor (MAC). The supplier was at serious risk of having its Medicare billing privileges terminated and its subsequent reenrollment in the federal health care program barred for two years.

The MAC claimed the revocation was based on the supplier’s non-compliance with Medicare’s requirements related to the timely filing and maintenance of a surety bond and a comprehensive liability insurance policy that covered the supplier’s place of business, customers, and employees.  

The documentation, corrective action plan (CAP), and accompanying arguments submitted demonstrated the supplier’s commitment to continued compliance with the Medicare rules, including rigorously training its employees and hiring a third-party compliance vendor. Coupled with the risk of interrupting services for numerous Medicare recipients during COVID-19, the MAC approved the CAP and reinstated the supplier’s Medicare billing privileges without ever having to move on to the reconsideration stage. 

The Barclay Damon team has successfully represented pharmacies and other providers in similar administrative proceedings before MACs and other governmental entities.

If you have any questions regarding the content of this post, please contact Linda Clark, Health Care Controversies Team Leader, at lclark@barclaydamon.com; Brad Gallagher, counsel, at bgallagher@barclaydamon.com; Mary Connolly, associate, at mconnolly@barclaydamon.com; or another member of the firm’s Health Care Controversies Team.

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