Adverse Action - Its Effect on Related Entities

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Posted On: April 25, 2017 by Essentially Women in: Essential News, Legislative

AMARILLO, TX - Assume that ABC Medical Equipment, Inc. is related to XYZ Medical Equipment, Inc. and DEF Medical Equipment, Inc. For example, assume that while the three companies do not have identical stockholders, John Smith and Jack Jones are stockholders of each company. Assume that ABC determines that Medicare paid claims to ABC that should not have been paid. Assume that ABC does not report and repay the overpayment to CMS. Assume that there is no evidence of improper claims submissions by XYZ and DEF. Assume that CMS, perhaps through an audit, determines that ABC (i) should not have been paid for claims and (ii) failed to report and refund. As a result, assume that CMS brings an adverse action against ABC in the form of a PTAN revocation. The question becomes: Will the adverse action against ABC negatively affect XYZ and DEF? It is this question that this article will address. Under Section 1866j(6) of the Social Security Act, the Secretary of the Department of Health and

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