what kind of lawyer can answer problems with medicare

If you have been denied such coverage, the best thing to do is to consult with a lawyer who specializes in Medicare and Medicaid law. Simply accepting a denial on a claim may not be a smart course of action. Many times, you do have legal recourse.

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Do I need a lawyer for Medicare benefits?

An experienced elder law attorney can serve as an advocate for you, increasing your chances of being approved for benefits. Medicare Fraud. On the other hand, if you are accused of obtaining Medicare benefits under false circumstances (called Medicare fraud), you could face fines or even jail time. An attorney can help defend you against these claims and reach an ideal …

When should I contact a Medicare attorney?

Although Medicaid and Medicare are run by the United States government, individuals do have rights under law. If you feel that those rights have been abused in any way, you need to speak to an experienced attorney. The hospitals, clinics and physicians who work with you should be forthcoming about your Medicaid or Medicare benefits.

What to do if you are not getting Medicare coverage?

Call 1-800-MEDICARE (1-800-633-4227) Biggie Productions / Getty Images. You can call 1-800-MEDICARE and speak with a representative to ask questions about Medicare or get help resolving problems with Medicare. We made a test call to this number and were greeted by a polite Medicare representative after being on hold for about 90 seconds.

How do I get help with Medicare questions?

To speak with our team of experienced medicare appeals lawyers in confidence, please call 888-680-1745 or inquire online now. Nick Oberheiden Dr. Nick Oberheiden, founder of Oberheiden P.C., focuses his litigation practice on white-collar criminal defense, government investigations, SEC & FCPA enforcement, and commercial litigation.

How can Medicare problems be resolved?

Your plan is the best resource to resolve plan related issues. Call 1-800-MEDICARE. Call 1-800-633-4227, TTY users should call 1-877-486-2048. If your concern is related to Original Medicare, or if your plan was unable to resolve your inquiry, contact 1-800-MEDICARE for help.Dec 1, 2021

How successful are Medicare appeals?

People have a strong chance of winning their Medicare appeal. According to Center, 80 percent of Medicare Part A appeals and 92 percent of Part B appeals turn out in favor of the person appealing.Jun 20, 2013

How do I dispute a Medicare claim?

Fill out a "Redetermination Request Form [PDF, 100 KB]" and send it to the company that handles claims for Medicare. Their address is listed in the "Appeals Information" section of the MSN. Or, send a written request to company that handles claims for Medicare to the address on the MSN.

What does a Medicare ombudsman do?

The Medicare Beneficiary Ombudsman helps you with complaints, grievances, and information requests about Medicare. They make sure information is available to help you: Make health care decisions that are right for you. Understand your Medicare rights and protections.

How do I fight Medicare denial?

File your appeal within 120 days of receiving the Medicare Summary Notice (MSN) that lists the denied claim. Circle the item on your MSN that you are appealing and clearly explain why you think Medicare's decision is wrong. You can write on the MSN or attach a separate page.

Who pays if Medicare denies a claim?

If Medicare refuses to pay for a service under Original fee-for-service Part A or Part B, the beneficiary should receive a denial notice. The medical provider is responsible for submitting a claim to Medicare for the medical service or procedure.

How long does Medicare have to respond to an appeal?

How long your plan has to respond to your request depends on the type of request: Expedited (fast) request—72 hours. Standard service request—30 days. Payment request—60 days.

Why would Medicare deny a claim?

Medicare may issue denial letters for various reasons. Example of these reasons include: You received services that your plan doesn't consider medically necessary. You have a Medicare Advantage (Part C) plan, and you went outside the provider network to receive care.May 18, 2020

Can you be denied Medicare?

In all but four states, insurance companies can deny private Medigap insurance policies to seniors after their initial enrollment in Medicare because of a pre-existing medical condition, such as diabetes or heart disease, except under limited, qualifying circumstances, a Kaiser Family Foundation analysis finds.Jul 11, 2018

What are the disadvantages of Medicare?

Cons of Medicare AdvantageRestrictive plans can limit covered services and medical providers.May have higher copays, deductibles and other out-of-pocket costs.Beneficiaries required to pay the Part B deductible.Costs of health care are not always apparent up front.Type of plan availability varies by region.More items...•Dec 9, 2021

What is the QIO in Medicare?

A Quality Improvement Organization (QIO) is a group of health quality experts, clinicians, and consumers organized to improve the quality of care delivered to people with Medicare.Dec 1, 2021

What is Medicare Part C called?

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow rules set by Medicare.

How long do I have to appeal my decision?

The length of time you have to file an appeal depends on the nature of your case. If you received an unfavorable audit determination from a ZPIC or...

What types of issues can you appeal in a Medicare fraud case?

Here, too, the answer depends on the type of situation with which you are dealing. If you are facing recoupment demands or denial of payments from...

Do I need to hire a new lawyer to handle my Medicare appeal?

While you do not need to hire a lawyer for your appeal (in other words, there is no legal requirement to retain new appellate representation), it w...

What happens if I lose my Medicare appeal?

This is an important question. From a purely legal perspective, if you lose your Medicare appeal, you have two options: (i) you can accept the deci...

What happens if I win my Medicare appeal?

This, too, is a question that raises both legal and practical considerations. While a successful audit appeal can lead directly to a favorable fina...

What are the stages of appeal for an unfavorable ZPIC or RAC Medicare audit determination?

These are the five stages of appeal for an unfavorable ZPIC or RAC Medicare audit determination: 1. Redetermination Redetermination is the first st...

What qualifications should I consider when choosing a lawyer for a Medicare fraud appeal?

In addition to the considerations discussed above regarding retaining your trial attorney or hiring new appellate counsel for your Medicare fraud a...

What are the different types of Medicare?

There are four main parts to the Medicare Plan: 1 Medicare Part A covers nursing care, hospice care, certain types of home health care, and inpatient hospital stays. 2 Medicare Part B covers many doctor’s services, as well as preventive services, medical supplies, and outpatient care. If you qualify, Part A and Part B are free, although there may be some services that are not covered or not fully covered and must be paid for. 3 Medicare Part C, or Medicare advantage, is designed to provide private insurance that covers any gap between what your regular Medicare covers and what you need covered. You will have to pay for Medicare Part C. 4 Medicare Part D provides prescription drug coverage.

What is Medicare insurance?

What Is Medicare? Medicare insurance is a public, government-run and funded insurance plan that provides health coverage for Americans 65 and older. Those with End-Stage Renal Disease are also eligible for Medicare, as are people with certain disabilities even if they are not yet 65.

What is Medicare Part B?

Medicare Part B covers many doctor’s services, as well as preventive services, medical supplies, and outpatient care. If you qualify, Part A and Part B are free, although there may be some services that are not covered or not fully covered and must be paid for.

What to do if you are denied Medicare?

If you have been denied such coverage, the best thing to do is to consult with a lawyer who specializes in Medicare and Medicaid law. Simply accepting a denial on a claim may not be a smart course of action. Many times, you do have legal recourse.

What happens if you are accused of fraud?

Otherwise, you put your rights at incredible risk and can end up facing a huge array of penalties and legal repercussions.

Do you have rights with Medicare?

It is important to keep in mind that when problems arise concerning Medicare and Medicaid, you do have rights. Familiarizing yourself with a few basic facts is a good way to begin:

Is Medicare and Medicaid confusing?

Medicare And Medicaid. The Medicare and Medicaid system in the United States can be tremendously confusing. When you are denied Medicaid benefits or otherwise have problems with a social welfare program, it can feel like you are all alone.

How to contact Medicare by phone?

Call 1-800-MEDICARE (1-800-633-4227) You can call 1-800-MEDICARE and speak with a representative to ask questions about Medicare or get help resolving problems with Medicare. We made a test call to this number and were greeted by a polite Medicare representative after being on hold for about 90 seconds.

What is Medicare Rights Center?

The Medicare Rights Center is a non-profit organization dedicated to helping Americans understand their Medicare rights and benefits, navigate the Medicare system, and get quality health care. It does this using the extensive library of information available on its website as well as through a telephone helpline.

What is Medicare.gov?

Medicare.gov is the official government website about Medicare. There are lots of private sites devoted to Medicare information and sales—some are very reputable, although some are not. But only the government website has the dot-gov domain name. 5.

What is a helpline counselor?

Helpline counselors offer assistance with Medicare questions like how to decrease your premium costs and with Medicare problems such as appealing payment denials. They can also provide extensive information regarding eligibility and enrollment, even for somewhat complicated situations.

What happens if you lose your Medicare appeal?

From a purely legal perspective, if you lose your Medicare appeal, you have two options: (i) you can accept the decision, or (ii) you can continue to appeal until you have exhausted your rights at all levels of the appellate process. There are five levels of appeal for ZPIC and RAC audit determinations; there are various levels of appeal in civil enforcement matters depending on where your case starts; and, there are two levels of appeal – the U.S. Circuit Courts of Appeal and the U.S. Supreme Court – for criminal convictions in federal district court.

How long does it take to appeal a Medicare audit?

However, in order to avoid recoupment liability, you must file within 30 days. In both instances, the clock starts running from the date you receive a demand for payment.

Can Medicare fraud appeal?

Medicare audit determinations, impositions of civil monetary penalties (CMPs), and criminal Medicare fraud convictions are all subject to appeal. In this article, the healthcare fraud defense attorneys of Oberheiden, P.C. answer common questions about Medicare fraud appeals.

What to do before accepting a settlement with Medicaid?

Before you do anything further - talk to a lawyer about creating a Special Needs Trust for you to protect this money from Medicaid . It should be done BEFORE you accept the settlement. If your personal injury lawyer does not know anything about this, have the lawyer call a certified elder law attorney to find out what needs to be done. ... Read More

What happens if your mother is not the owner of the policy?

If your mother is not the owner of the policy then it is not her asset so you do not disclose the ownership of that asset. It is outside the five year look back period.

What is supplemental needs trust?

You absolutely need a supplemental needs trust which will enable Evan to keep both his inheritance and his government benefits. The trust needs to be approved by Medicaid and contain a provision that if any money remains when Evan passes away it goes to Medicaid. The trust agreement must appoint a trustee who is responsible for keeping records of expenditures and... Read More

Is a term policy an asset?

If it is a term policy, it has no cash surrender value is not counted as an asset. However, you will have to continue to pay any premiums required, as your husband will not be able to make those payments.

Is MRSA a "never" event?

I do not believe that MRSA is a "never" event. A "never" event is an event that is never supposed to occur - such as he amputation of the wrong limb. there are certain "punishments" that are enacted if a hospital or facility are found to have done a "never" event - such as the facility does not receive payment from Medicaid or Medicare. I do not believe an... Read More

Can you negotiate with Medicaid?

You may be able to negotiate with Medicaid, but it may also be that there is a lien against your dad's estte, and when he passes, if there are any assets, its gets paid out of the estate.

How does Medicare work?

The Medicare system sucks money from the public treasury and from consumers’ wallets and erro neously pays them out. The Medicare system makes scamming seniors easy. Many times, false bills are sent to senior citizens over 100 days after the senior’s insurance company had already paid the bill.

What are some examples of socialized medicine?

Here are three examples: Nazi Germany: Over six million Jews and various dissidents were murdered in concentration camps.

What are some examples of socialism?

Here are three examples: 1 Nazi Germany: Over six million Jews and various dissidents were murdered in concentration camps. The government decided that they did not need healthcare, or the same level of healthcare as other people favored by the government. The official name of the Nazi Party was National Socialist German Workers Party. Adolph Hitler and the Nazis were socialists. That socialist government decided who would and who would not get health care. 2 Syria: The Arab Socialist Ba’th Party has governed Syria for decades. Government health care is provided only if you don’t disagree with government officials. Doctors aren’t free to serve those who need medical help. Citizens who are not favored by the government must pay bribes to government officials in order to get needed health care. Doctors who give medical attention to wounded enemies of the government are routinely arrested, imprisoned, tortured, and killed. 3 Venezuela: This country rich with natural resources enough to create and sustain a vibrant economy is today under extreme civil unrest, due to its socialist policies.

Who is Woodrow Wilcox?

Woodrow Wilcox is the author of the book “Solving Medicare Problem$.”. For more than 16 years, he has helped senior citizens fight mistakes and fraud in the Medicare system. Wilcox has saved senior citizens over two million dollars by not paying bad medical bills.

Is Medicare for all bad?

Is that really what you want for America? America wants a private health care system where patients pay money to a doctor rather than pay a bribe to a government official. “Medicare for all” is a really bad idea. Woodrow Wilcox is the author of the book “Solving Medicare Problem$.”.

Was Hitler a socialist?

Adolph Hitler and the Nazis were socialists. That socialist government decided who would and who would not get health care. Syria: The Arab Socialist Ba’th Party has governed Syria for decades. Government health care is provided only if you don’t disagree with government officials.