Providing Strong Advocacy For Medical Professionals In Texas For Over A Decade

Texas Medicaid And Medicare Overpayment

From time to time, health care providers may receive incorrect Medicare or Medicaid payments. Most often, the issue is an overpayment involving errors with the amount paid and the service billed. For many health care providers, it is simple to resolve these issues with a refund or billing adjustment. Unfortunately, the problem can be a lot more serious if the overpayment is not discovered and goes unresolved for a long time or when there are high numbers of overpaid claims.

When the Medicare or Medicaid system detects an overpayment, the government will seek to recoup the alleged overpayment or seek fraud charges. The consequences for a provider’s financial well-being and professional reputation are exceptionally severe in these matters. This makes it necessary to seek the advice of an experienced health care lawyer to solve your Medicaid overpayment issues and suspected fraud.

I am attorney Alejandro Mora, and I am prepared to help you appeal Medicare and Medicaid overpayments. From my law office in Austin, my team and I serve health care professionals in Dallas-Fort Worth, Houston, and San Antonio and throughout Texas. Call The Law Offices of Alejandro Mora, PLLC, today at 512-937-1128 for a free initial consultation.

Experienced Counsel From A Health Care Law Attorney

I understand the labyrinth of regulations that govern Medicaid and Medicare. I thoroughly understand the procedures that the government uses when pursuing Medicaid and Medicare overpayment claims. I can provide you with the information you need to make educated decisions about the course of action you want to pursue.

The overpayment process typically includes:

  • Demand letters: Upon detection of a potential overpayment, Medicare or Medicaid will send a demand letter requesting payment. You only have 30 days to respond to this letter before interest begins to accrue and additional collection efforts begin.
  • Rebuttal statements: You can submit a rebuttal to the overpayment within 15 days of the date on the demand letter. This allows you an opportunity to show evidence that there was no overpayment.
  • Appeals: Any appeal of a determination of overpayment may go through many levels of appeal. This includes a request for a redetermination decision with a recovery audit contractor (RAC), an appeal to a qualified independent contractor (QIC) and further appeals beyond those initial stages. At any stage of an appeal, your choice of lawyer can greatly impact the outcome of the appeal.
  • Recoupment: To recover the amount of the alleged overpayment, Medicare will initiate the recoupment process. This process takes a portion of the allegedly owed amount from future Medicare payments to the provider.

No matter where you are in the process, I am ready to step in and get to work on your case immediately. I will walk you through each step of the process, from reviewing every piece of claim data to hiring experts to support your case.

Attorney For Overpayment Appeals

I help my clients by offering them legal advice and representation throughout the overpayment determinations process. My method is simple: I go as far up the appeal levels as necessary and gather as much evidence as I can to show that our clients’ claims were proper.

Losing overpayment appeals can be devastating. Some determinations involve such massive amounts of money that losing the appeals process would put our clients out of business. I understand what is at stake. I make my clients’ concerns my concerns.

A Growing Problem For Medicaid Providers

The Texas Health and Human Services Commission has attempted to prevent fraud and pursue fraudulent abuse of the Medicaid system by devoting a steadily increasing amount of resources to pursuing overpayment claims. The commission has gathered additional funding and support for data mining – a process where advanced algorithms seek to find patterns and correlations in large amounts of data. This is done to comb through the payments the state has made to health care entities and individual providers so they can look for potentially fraudulent behavior and overpayments on Medicaid claims.

I regularly travel to all corners of Texas to represent providers and consult on matters involving Medicare and Medicaid overpayment, audit, appeal and fraud investigations.

Contact My Office And Take The First Step Toward Resolving Your Issue

Call 512-937-1128 or complete my online form to begin the conversation about Medicare and Medicaid overpayments.