Buchanan Ingersoll & Rooney recently secured a major win for an independent pharmacy facing revocation of its Medicare enrollment as a Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) supplier. The Centers for Medicare & Medicaid Services (CMS), through its contractor Novitas Solutions, had revoked the pharmacy's enrollment and imposed a one-year reapplication bar—citing alleged noncompliance with liability insurance requirements. However, the revocation was based on erroneous allegations. Attorneys Dae Lee and Kelly Reynolds stepped in, challenged the revocation, and successfully secured a full reinstatement of our client's DMEPOS billing privileges.
Case Background
The Wisconsin-based pharmacy, a long-standing provider in its community, was blindsided when Novitas Solutions alleged that the pharmacy had failed to maintain comprehensive liability insurance—an essential requirement under Medicare supplier standards. Despite the pharmacy's consistent insurance coverage, a documentation issue led to a revocation of its billing privileges and a one-year bar from re-enrollment. This action not only jeopardized the pharmacy's ability to serve its Medicare patients but also placed the financial health of the business at risk.
Buchanan's Legal Strategy and Intervention
With time running out, the pharmacy turned to Buchanan for strategic legal intervention. We quickly assessed the situation and moved to file an appeal before an Administrative Law Judge (ALJ). We gathered comprehensive documentation to demonstrate the pharmacy's uninterrupted liability insurance coverage and addressed the procedural missteps that led to the revocation.
Our team submitted a compelling appeal, reinforced with supporting evidence and legal analysis, to counter Novitas' position. Despite the uphill battle of joining the case at a late stage in the appeals process, we were able to pierce through the barriers and set the record straight. The pharmacy was reinstated and able to resume full Medicare operations and reaffirmed the critical role of experienced counsel in navigating Medicare compliance and enforcement proceedings.
Lessons Learned: Protecting Your Business
This case underscores the importance of meticulous recordkeeping and proactive legal representation. Medicare suppliers, especially those dispensing DMEPOS items, are under increasing scrutiny. Even minor administrative oversights can lead to severe consequences, including revocation and financial loss. Partnering with counsel experienced in healthcare regulatory defense can make the difference between operational disruption and full recovery.
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