Sunday, November 30, 2003

Cracking down on fraud
with J. Everett Wilson

Q. My DMERC supplier company has just received a notice from my regional carrier, Palmetto GBA, indicating that they will be terminating our supplier number due to our failure to meet some of the supplier standards. What should we do?

A. During the last several months, carriers have been issuing notices to suppliers indicating that they have failed to meet certain standards and their supplier number will be terminated. The notices are related to Operation Wheeler-Dealer, and they illustrate that the federal government is aggressively pursuing fraud. In addition, the notices offer an opportunity to submit a request for reconsideration along with all of the documentation necessary to demonstrate compliance with supplier standards. They also indicate that the supplier may request a hearing. Failure to request reconsideration or a hearing may result in the supplier’s number being terminated, leaving them with no legal recourse to appeal the decision. We advise that suppliers request both reconsideration and a hearing, include all of the documentation required to address the alleged noncompliance and obtain proof that it is received by the carrier. While we have already begun assisting suppliers with their requests, it is still too early to predict what the final interpretation of this supplier standard will be.

Healthcare attorney J.Everett Wilson, Esq., is the managing partner of the law firm of Wilson Suarez Lopez & Gennett. Reach him at (305) 446-7300.