Health Law Daily Traveling foot care practice not located in mailbox, booted from Medicare
Monday, February 26, 2018

Traveling foot care practice not located in mailbox, booted from Medicare

By Dietrich Knauth

A foot care practice that listed a UPS mailbox as its only practice location lost its Medicare enrollment because it never properly informed its Medicare Administrative Contractor (MAC) that it performed services solely in patients' homes. An administrative law judge (ALJ) for the HHS Departmental Appeals Board (DAB) affirmed CMS’ revocation of the foot care practice’s Medicare enrollment and billing privileges (Toe-Tal Family Foot Care Associates, P.C. v. CMS, Docket No. C-17-773, Decision No. CR5006, January 9, 2018).

Toe-Tal Family Foot Care Associates argued that Noridian Healthcare Solutions, its MAC, improperly revoked Toe-Tal’s Medicare enrollment after a site visit to its UPS mailbox, which was listed on the enrollment application as the foot care practice’s sole practice location. Toe-Tal argued that its practice "is mobile and services are rendered in patient homes and facilities," and that it had used the same address for Medicare purposes since 2006 without any problems.

The ALJ found, however, that Toe-Tal had listed the mailbox as a health care facility on its application, and reported that it saw its first Medicare patient at this location in 2006. The revalidation application specifically instructed applicants not to report post office boxes, and said that practitioners who only render services in patients’ homes should use their home address as the practice location; such practitioners are directed to explain that all services are rendered in patients’ homes in a later section of the application. Toe-Tal did not follow these instructions. Because it failed to properly inform Medicare of its actual practice location, the ALJ upheld Noridian's revocation of Toe-Tal’s Medicare enrollment and a two-year re-enrollment ban.

The ALJ also rejected Toe-Tal’s efforts to exclude from evidence an unsigned report of a CMS site visit. The ALJ determined that Toe-Tal did not dispute the report's conclusion that the address was a mailbox and not a medical office. Although the ALJ noted that CMS’ failure to submit a signed site verification report could be an evidentiary problem under other circumstances, in this case the lack of a signature did not make the report inadmissible.

Companies: Toe-Tal Family Foot Care Associates, P.C.; Noridian Healthcare Solutions

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