Physician-owned Ambulatory Surgery Center issued favorable reconsideration decision in Medicare overpayment appeal

Client(s) Physician-owned Ambulatory Surgery Center

Jones Day represented a physician-owned Ambulatory Surgery Center ("ASC") in a recent appeal on claims wherein C2C Innovative Solutions Medical Center, a Medicare contractor, returned a favorable reconsideration decision for the ASC. The primary issue on appeal was whether supervised exercise or pharmacological therapy should have been attempted prior to performance of revascularization procedures. With the help of a clinical expert, Jones Day argued that neither supervised exercise therapy nor medication were appropriate or safe for the patients at issue. In the recent decision, C2C agreed, rendering a favorable decision on 98% of the $1.27 million in claims on appeal. This decision is particularly notable because it occurred at the second appeal level where it has historically been more difficult for providers’ arguments to gain traction.