Author: Carolyn McKaige

In a recent Medicare conditional payments case involving a 1999 asbestos settlement, Allan Koba Compliance Solutions successfully navigated a series of legal and procedural challenges to deliver over $54,000 in savings to the client.

Case Facts

Claimant sustained work-related exposure to asbestos in 1993.  The workers’ compensation claim settled in 1999.  Twenty-six years later, Medicare’s Commercial Repayment Center (CRC) issued a $54,172.24 demand seeking reimbursement for medical treatment.  At issue was relatedness of the conditional payments to the date of accident, apportionment, as well as no overlap in Medicare coverage between the settlement and Medicare entitlement. To complicate matters, as the claim was over twenty-six years old there were minimal documents available to utilize as supporting evidence.   

 A Strategic, Multi-Level Approach Leading to Success

The matter escalated through several procedural stages, beginning with appeals to the CRC and subsequently to Maximus Qualified Independent Contractor. Recognizing the importance of preserving all available arguments, Allan Koba Compliance Solutions also filed for an Administrative Law Judge (ALJ) hearing while simultaneously pursuing a reopener at the CRC to ensure every possible avenue of review was explored. Allan Koba Compliance Solutions identified and applied state specific statutes addressing record retention requirements for public utilities and the California Department of Labor, arguing that the sought after supporting documents had been destroyed as it was well past any data retention policy. Allan Koba Compliance Solutions also highlighted the multiple services that were unrelated to the reported injury of asbestos exposure, as well as the apportionment of liability amongst the multiple defendants, and that there was no overlap in Medicare coverage with the date of accident. Ultimately, Allan Koba Compliance Solutions received a favorable decision from the CRC. This proactive intervention effectively prevented further appeal to the ALJ and provided $54,000 in savings to the client.

 

How We Can Help

If you have questions regarding Medicare compliance matters, no matter how old or how tough, please reach out to Allan Koba Compliance Solutions. Our legal and medical expertise will guide your case-specific needs and walk you through each step of the process. Stay tuned for more updates and feel free to reach out with any Medicare-related questions at info@allankoba.com.