Thursday, May 2, 2024

FW: medicare ALJ hearing/non-hearing

David Sisson

> >
> >
> >
> >
> > Here is the next chapter in the over two year old first and only CERT
> > audit I have cooking. I have to say I have been using the wrong
> > acronym in my previous postings I have said rac but meant cert. (the
> > rest are all pre-payment right now). I delivered the denied socket
> > change on 2-3-2011.The CERT audit started8-29-2011 they took back the
> > money in october 2011. All the other appeals were performed. I
> > requested an in person alj hearing on 6-15-2012 I never heard back
> > from them and sent another letter asking what is happening on
> > 12-11-2012 on
> > 1-15-2013 I get a letter denying an in person hearing, on 1-28-2013 I
> > get a notice of a telephone hearing scheduled for today at 12:30 cst .
> > On
> > 1-30-2013 I get a letter confirming the telephone hearing/exhibit list.
> > TODAY at 12:23 p.m. I get a phone call from the Judges asistant and
> > She says that after reviewing the case He has granted Me a full
> > favorable finding and there is no need for a hearing…I was a bit
> dumbfounded to say the least.
> > I asked if and or when I could expect a letter confirming this, She
> > got a bit gruff and said “I have absolutely no idea” when I asked her
> > again when I could expect payment she said again ” I have absolutely
> > no idea , look he hasover 1,600 cases on his docket and I have no idea
> > when he will get around to writing them up he’ll get to it when he
> > gets to it !” when I asked if I should call back in 90 days if I
> > haven’t heard anything She said “You can if you want to.” and gave me
> > Her name and phone number. So I finally won and I may see my money
> > within two and one-quarter years of doing the work . I’m pretty sure
> > I’ll win my other appeals this way too, but waiting over two years to
> > get paid is not viable for materials and labor I paid for over two
> > years ago. I cannot fault the ALJ or his staff. They have a crushing work load due to the the tidal wave of denials and take backs. Butt the providers and beneficiaries are getting screwed. the auditors are just doing what they are contracted to do. HHS hello are you listening ? David Sisson C.P.BOCO
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> > and Prosthetics.
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> ******************** To unsubscribe, send a
> message to: [email protected] with the words UNSUB OANDP-L in the body
> of the message.
>
> If you have a problem unsubscribing,or have other questions, send e-mail to
> the moderator Paul E. Prusakowski,CPO at [email protected]
>
> OANDP-L is a forum for the discussion of topics related to Orthotics and
> Prosthetics.
>
> Public commercial postings are forbidden. Responses to inquiries should not
> be sent to the entire oandp-l list. Professional credentials or affiliations
> should be used in all communications.
>
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