California Federal Court Recommendation Rejects Right of Providers to Challenge Reopening of Claims by Medicare Contractors

In the case of Palomar Medical Center v. Sebelius, pending in the U.S. District Court of the Southern District of California, the federal Magistrate Judge has entered a report and recommendation finding that providers do not have the right to challenge a Medicare contractor’s reopening of a claim for lack of “good cause” for the reopening. Under applicable Medicare regulations, there must be good cause for the reopening of a claim by a Medicare contractor where the claim is more than one year and less than four years old (42 C.F.R. §405.980(b)(2)).

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