The delay accumulated by Medicare calls at the ALJ level is unacceptably long. See blog and blog. However, federal regulations only prevent recovery during the first and second level appeals process. It is absolutely asinine and it should be changed when we consider that we have a clause in the Constitution called „due process.“ Suspected criminals have due process, but health care providers who accept Medicare or Medicaid sometimes do not. Juxtapose, a health care provider who opposes an alleged overcompensation, but during the appeal process, another penalty is imposed – the state or the federal government begins to recover future funds before deciding that the alleged recovery is authorized, legal or justified. If a brand new subject, which has nothing to do with the accusation of overpayment, fits into the mix, then you have spaghetti and meatballs with a side of sharp greens. The green-collar should be invoked in a totally different way than spaghetti and meatballs, especially if the green collars could take the company out of the business in the absence of an appropriate procedure due to premature and unjustified repair. SB 257 proposes that if you are terminated, „the termination reflects the supplier`s inability to complete the verification of advance applications and leads to the exclusion of the provider from future medicaid participation. Even if you resign voluntarily. No Mulligan. No training to improve. You will never be able to offer Medicaid services again.
The conical frame has been closed. SB 257 proposes that you be punished for appealing for dismissal. If you do not complete the 70% accuracy for three consecutive months, you will be terminated by the Medicaid program. In the case of SB 257, however, if you file an appeal against this termination decision, „until the final decision of termination or another sanction from the supplier, the supplier will remain in the prepayment review.“ Normally, if you challenge an adverse provision, the adverse provision „will remain“ until the end of the litigation. In a healthcare world where cooperation between providers is encouraged and recommended, anti-kickback, strong and HIPAA laws are outdated and do not recognize the world today. Existing federal laws on health fraud and abuse create a „silo effect“ that requires mapping and separating the financial interests of health care providers to ensure that patient transfers cannot be masked by their own interests.