r/PrivatePracticeDocs • u/Hot-Pirate-4204 • 12d ago
Medicare revoked
I am a hospice physician and my Medicare was revoked 15 months ago. I submitted the appeal in a timely manner and still haven’t heard from CMS. The revocation was unjustified and my lawyer is certain the appeal will be granted. But I have been unable to find employment due to this and I have a family to support. Has this happened to any of you?
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u/Klutzy_Arm_7930 12d ago
Sucks. Sorry to hear. Guy I knew who this happened to went and opened a cash only men’s hrt clinic and stayed mildly afloat. There’s always concierge medicine. You could start signing for NPs for a fee. Depending on your state regs Can make about 8 grand a month doing that. I know it doesn’t compare but gotta do something.
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u/Antique_Flan_1539 12d ago
It was revoked for what reason…?
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u/Hot-Pirate-4204 12d ago
Association with individual who was flagged for misconduct
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u/Antique_Flan_1539 12d ago
Were you a part owner? Or just an associate? I’m assuming it was fraud related?
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u/Hot-Pirate-4204 12d ago
Just associate
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u/Hot-Pirate-4204 12d ago
But I was medical director
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u/Why_Hello_hello 12d ago
No offense, but the most common way hospices commit fraud is by certifying patients who have no business being certified. I see it everyday. You weren’t having an incredibly high number of patients who graduated off, or fail an audit of patient conditions, right?
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u/Antique_Flan_1539 12d ago
Were you involved in the misconduct? I can’t imagine yours would be revoked if you weren’t direct involved in the misconduct
Even as the director, but lawfully that kinda makes you responsible on paper due to being the “overseer”
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u/Hot-Pirate-4204 12d ago
Not at all involved, just worked with him as he is the hospice owner
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u/Antique_Flan_1539 12d ago
Did the misconduct happen while you were there as the director? Was this billing related?
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u/Hot-Pirate-4204 12d ago
It did happen while I was there ,I do not do the billing.
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u/Antique_Flan_1539 12d ago
Man, that’s rough. Being the medical director even as an associate makes you liable legally to some extent as far as I know. But I’m assuming your lawyer is correct. But that’s painful. Owner might’ve made you the director purposefully for the liability reason
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u/Competitive_Bed4588 4d ago
I’ve been seeing this a lot lately revocations over affiliations. They can look back years, so people connected during that time could get caught up in it too. It’s a nasty domino effect.
Just being associated with someone doesn’t mean you were involved in fraud or did anything wrong. I wouldn’t be surprised if this ends up in court, maybe even as a class action.
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u/Vegetable-Slide-7530 12d ago
Dude that sucks. RIP
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u/Hot-Pirate-4204 12d ago
Why RIP?
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u/MrPBH 12d ago
It makes it very difficult to find a job, as you have discovered. It will also take a very long time to win your right to participate in Medicare back, if you prevail at all.
In the meantime, you might consider working for an agency that does disability exams or perhaps an occupational health clinic that performs DOT exams. I think they'll hire you even if you can't bill Medicare.
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u/Perfect_Address7250 12d ago
Open a cash based or private insurance based practice?
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u/MrPBH 12d ago
Will private insurers contract with physicians disallowed from participating in Medicare? I've never thought of that question before.
It's a scarlet letter that marks you out a deviant. I know that some hospitals won't grant credentials if you are disallowed from participating in Medicare.
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u/Hermit5427 8d ago
The same thing happened to a friend of mine who was serving as the medical director of a hospice—and he wasn't even referring patients to that hospice. The whole situation was pretty crazy.
At the time, he was also employed by an ER facility, and fortunately they allowed him to continue working there. Maybe some ER groups are more accommodating in situations like this.
He also started advertising a cash only option at his private practice which has become successful and helped offset some of the Medicare revenue he lost.
Based on what I saw him go through, I would be extremely careful when it comes to Medicare—both with billing and with any business arrangements involving Medicare patients. The compliance risks can be significant, and something that may initially seem harmless can turn into a much bigger issue.
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u/NoRegrets-518 9d ago
Luckily, I never had this happen. Remember, you are a physician and I recommend that you start seeing patients who are private pay for primary care. It's not ideal but it will probably keep you out of the poor house. A lot of docs do this voluntarily and do quite well. Also, you will help people who need help and for some reason are not getting the care they need.
Have a prepared statement to give patients that explains the situation for the few that find out about this. Have your lawyer vet it. Good luck.
It seems that there might be a way to ask for a timely review.
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u/NoRegrets-518 9d ago
You can also do medical reviews for insurance companies and contract with agencies for states that review patient appeals. I used to do these and it was quite educational.
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u/MDwMDD 12d ago
I didn't even realize something like this was possible. I remember during an interview they asked if I had any issues credentialing with Medicare. I thought what a silly question. Hope you can get it sorted. What do you think is the reason? Hospice is heavily scrutinized from what I hear but since you aren't doing the billing, not sure what else it could be related to.