It depends.

For a Notice of Overpayment? Providers should request a reconsideration review and hire an attorney.

For a denial of endorsement? Providers have very limited time to appeal a denial. Hire a lawyer. Appeal as the denial explains.

For a Medicaid recipients’ rights? Most appeals will be to the Office of Administrative Hearings (OAH).

I wrote the above “blog” back in 2012. It was one of my first blogs and one of my shortest. Looking back, I must admit that the blog is not even good…it’s accurate-ish. I cannot believe that I have been blogging for over 10 years of my life…and about Medicare and Medicaid regulatory compliance litigation — who knew?

As the year ends, I want to thank all my readers for reading this blog for TEN YEARS. I am humbled and appreciative. As all of you are aware, I do not get paid to blog about Medicare and Medicaid. It actually eats-up quite a lot of my time, which I do not have in Spades, as a mother of a Senior in HS, a wife, and an attorney.

Now I will rewrite the 2012 blog for 2022-2023:

Health Care Providers: Where Do You File an Appeal?

If you are filing a Medicaid provider appeal claiming that you do not owe an overpayment, your State will have an administrative process for you to seek redress. You must exhaust administrative remedies, so read the notice of overpayment for clarification of the 1st and maybe 2nd steps. You normally have a reconsideration and a red-determination before presenting to an administrative law judge.

Hire a lawyer from the beginning.

If you are filing a Medicare provider appeal, see blog. Still hire an attorney.

I look forward to another year of defending health care providers against the State and federal governments. I see it as I have the chance to keep health care providers in business and accepting Medicaid and Medicare. Thank you for accepting Medicare and Medicaid, and I will be here to fight!! I have represented providers from Alaska to New Mexico to New York and Florida and all in between!