Loss of Provider Status and Insurance Audits
The Law Offices of Joseph J. Bogdan, LLC

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United States Lawyer Defending Doctors Against Loss of Provider Status

U.S. Medicare/Medicaid enrollment defense attorney

Attorneys Assisting Medical Providers With Insurance Audits and Medicare/Medicaid Enrollment Issues Throughout the U.S.

Most patients in the United States rely on health insurance providers or government programs such as Medicare and Medicaid to cover the costs of medical care. Being able to provide services through these programs is crucial for doctors, pharmacies, and other medical professionals, and they will need to address any issues that could cause them to lose their provider status. A lawyer who is skilled in the various areas of healthcare law can provide invaluable legal help in these cases to ensure that medical providers will be able to continue practicing in their chosen field.

The attorneys of the Law Offices of Joseph J. Bogdan, LLC have the knowledge and skill needed to help medical providers avoid penalties that affect their ability to practice. With nearly two decades of experience representing medical professionals in cases involving medical licensing, controlled substances, and board certification, we can make sure you do what is needed to avoid the revocation of your Medicare/Medicaid enrollment or your provider status with insurance companies.

Insurance Audits and Issues Affecting Provider Status

The Centers for Medicare and Medicaid Services (CMS) regularly conducts audits of medical providers to ensure that they are following the correct practices. These audits may be performed by Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), or Zone Program Integrity Contractors (ZPICs), who will be looking to identify overpayments or underpayments, ensure that claims are processed correctly, and uncover fraud. Audits may also be performed by private insurance companies, and these audits may review medical records and billing records, or auditors may interview providers and staff members.

An audit may uncover instances of fraud, improper billing practices, noncompliance with enrollment requirements, or other issues that lead to the revocation of Medicare/Medicaid enrollment or the loss of provider status with private insurers. A medical professional may also face the revocation of their provider status based on other factors. Some common reasons for the loss of provider status include:

  • Abuse of billing privileges - An audit may find that a provider submitted fraudulent claims for services that were not actually provided to patients, or they may have submitted claims that did not meet the requirements of Medicare/Medicaid or a private insurer.
  • Medical license discipline - Complaints from patients, medical malpractice lawsuits, or other issues may lead a state licensing board, such as the Illinois Medical Board, Illinois Board of Nursing, or Illinois Board of Pharmacy, to take disciplinary action against a provider's medical license. The suspension or revocation of a professional license may lead CMS or private insurance companies to revoke a person's provider status.
  • DEA enforcement actions - A provider may be subject to a DEA investigation due to concerns about improper prescribing practices or unlawful dispensing of controlled substances. The decision to revoke a professional's provider status may be based on the suspension or revocation of a DEA registration or the denial of a DEA registration renewal.
  • Criminal convictions - Certain types of state or federal felony convictions can lead to the revocation of provider status. In addition to convictions for crimes related to drug diversion and drug trafficking, other offenses that may play a role in these decisions include financial crimes, violent crimes, sex crimes, or criminal neglect related to medical malpractice.

Contact Our U.S. Provider Enrollment Defense Lawyers

If you are facing the loss of provider status, the Law Offices of Joseph J. Bogdan, LLC can help you understand your legal options. We can work with you to negotiate an agreement with an insurance company or create a corrective action plan with CMS. We can also help you appeal an unfavorable decision and help you regain the ability to provide services to patients. We will do everything we can to make sure you will be able to continue practicing and avoid negative effects to your livelihood. Contact us at 630-310-1267 to arrange a free consultation and learn more about how we can assist with your case.

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