Audits

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Thursday, October 31, 2002

SANDWICH, Mass. — A provider who spent roughly $50,000 fighting and winning a recoupment battle with Medicaid has upped the ante in his battle against the state's "scare" tactics.
Mark Sheehan, president of Cape Medical, has lined up a sponsor for legislation that would require the state to repay a provider's legal fees if he successfully defends himself against overpayment allegations.

"They've beat people to death with (audits) for years," Sheehan said. "They continue to blame pharmacies, doctors, whoever for problems when the problems are the division's. They audit everyone and go about it the same way. They start with a big number, scare you and try to get a settlement. But if you fight them you win."

Rep. Ruth Provost agreed to introduce the new legislation in early 2003 — and with good reason, Sheehan said.

Last spring, Provost, upon being discharged from the hospital, felt she needed a hospital bed but her insurance company wouldn't pay for it. She couldn't believe the hassle, Sheehan said.

"She was more than happy to work with us because she'd been victimized by the system just like the rest of us," Sheehan said.

Provost did not return phone calls, but an aid did forward to HME News the bill's language.

Sheehan's tussle with Massachusetts Medicaid goes back several years. In 2000, he closed his rehab department, calling Medicaid an unreliable payer that owned him $150,000. "I can't continue to buy product on the hope that I am going to get paid," Sheehan said at the time.

On March 29, 2002 the Division of Medical Assistance Board of Hearings issued a preliminary ruling that threw out most of the state's claims that Sheehan owed Medicaid $247,000 due to faulty billing practices. Pending approval by DMA Commissioner Wendy Warring, it looks like Sheehan will be on the hook for less than $15,000. The commissioner generally follows the board's recommendation, provided it's fair and reasonable.

Sheehan spent about $50,000 fighting that allegation, and six months after the board's ruling Warring has yet to rubber stamp the ruling. That irks him. Thus his current attempt pass legislation to help wrongly accused providers recoup their legal costs.

"I said alright. If you guys want to make life miserable for me, I'll put the politicians on you and make life miserable for you," Sheehan said. HME

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