Favorable Outcome: Medicare Privileges

As part of its healthcare practice, Weitz Morgan represents pharmacists regarding a variety of issues. Recently, the firm concluded a six-month effort to help a small pharmacy in Houston, Texas regain its in-network contract and its Medicare privileges after both had been terminated. The termination of its in-network contract followed six months of auditing that saw the network rely on isolated and specious claims to justify termination. Medicare did not even provide a reason for termination.

The firm actively pursued the client’s appeal remedies contained in both its network contract and Medicare agreement. Five minutes prior to a formal hearing on the client’s network appeal, the network relented, withdrew the termination, and issued a letter of correction. Ten days later, faced with the client having invoked its right to arbitration, Medicare also withdrew its termination and instead issued a letter of correction.

Dealing with these types of issues, particularly within the federal government, require persistence and knowing the law.  Weitz Morgan is pleased that it could help the client overcome this formidable hurdle to its continued business operations.