For the first time in the District of South Carolina, and the Fourth Circuit, a Medicare provider has successfully obtained a district court order enjoining CMS from recouping Medicare payments following an overpayment determination.
This case presents an opportunity to all Medicare providers with a valid defense to overpayment determinations, but who are financially struggling through recoupment while waiting years for their ALJ hearing, to obtain desperately needed relief prior to hearing. Due to Medicare’s inability to provide an ALJ hearing in less than 1,200 days, the court found that the provider had been denied due process by the failure in the administrative system provided.
With nearly $1 trillion dollars of claims trapped in the administrative appeals process while Medicare continues to recoup, this is an extraordinary victory and sign of hope for the many providers financially suffering due to government failure.
