After being audited by Medicare and hit with a $150,000 recoupment demand, California primary care physician Robert E. Feiss was determined to fight the findings.
Auditors had declared that Dr. Feiss was providing care to patients in their homes that did not qualify as being medically necessary. He appealed, and after 3 long years of paperwork, petitions, and hearings, the doctor was successful in overturning the decision.
Courtesy Ella Castillo
California primary care physician Dr. Robert Feiss treats a patient at her home. Dr. Feiss was recently audited by the government and won his appeal against the finding.
“It was a scary thing, without a doubt,” said Dr. Feiss, who is in private practice in Ventura, Calif., and treats a large population of seniors in their homes. “But I felt very strongly about what I do and am committed to what I do. It’s a bittersweet victory because, aside from the incredible stress it took, there was no recovery of legal fees. There was no recovery of damages or of the time spent away from my practice.”
Dr. Feiss’s experience is not unique. He is one of thousands of health providers who decide to appeal their audits by the federal government. Win or lose, audit experts say the course of an audit appeal is often long and arduous. Along with financial uncertainty and legal expenses, physicians face substantial delays before their case can be resolved. The wait time for an appeal to be assigned to an administrative law judge is about 2 years, according to a December 2013 letter from the Office of Medicare Hearings and Appeals (OMHA). After assignment, it’s another 6 months before the case is heard.
The wait times reflect OMHA’s enormous backlog of appeals. In fiscal 2013, OMHA received 384,151 new appeals, up from 59,600 in 2011, according to July testimony before Congress by Nancy J. Griswold, OMHA chief administrative law judge. Fiscal 2014 appeals through July 1 totaled 509,124. More than 800,000 OMHA appeals were pending as of July, and the office continues to receive 1 year’s worth of appeals every 4 to 6 weeks, Judge Griswold said. In July a coalition of medical associations, including the American Medical Association, wrote a letter to OMHA urging the agency to immediately remedy the excessive surplus.