Circuit court: CMS had right to request info beyond CMN

Sunday, November 19, 2006

ATLANTA - A U.S. Court of Appeals has sided with CMS in a dispute over whether the agency had the right to request power wheelchair documentation beyond CMNs from Gulf Coast Medical.

The 11th Circuit Court's Nov. 3 decision is "significant," healthcare attorneys said, because the court has jurisdiction over three states: Georgia, Florida and Alabama.

"When a circuit court makes a ruling, it's the law of the land in those states," said Jeff Baird, a healthcare attorney with Brown & Fortunato in Amarillo, Texas.

Also, "now, three courts have made the same decision," said Asela Cuervo, a Washington, D.C.-based healthcare attorney.

Previously, a federal district court in Florida sided with CMS over Gulf Coast Medical. In March, another district court sided with the agency over the Maryland-based Mackenzie Medical.

But one high-profile case is still outstanding. Last year, a federal district court sided with the California-based Maximum Comfort, saying CMS wrongly demanded that the provider repay $600,000 for not supplying documentation beyond CMNs. CMS appealed the decision, sending the case to the 9th Circuit Court. The two parties now await a court date.

If the 9th Circuit Court sides with Maximum Comfort and CMS appeals again, the case would move up to the U.S. Supreme Court, Baird said. The Supreme Court's decision would be the lay of the land--in all states.

But Maximum Comfort shouldn't be too disheartened by the 11th Circuit Court's decision, Baird said. While its decision may influence other circuit court decisions, "it's not a Herculean obstacle," he said.

CMS wants Gulf Coast Medical to repay about $200,000 related to 16 power wheelchair claims.