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A & K Medical Supplies v. United States Department of Health and Human Services; Kathleen

May 17, 2012

A & K MEDICAL SUPPLIES, PLAINTIFF,
v.
UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES; KATHLEEN SEBELIUS, IN HER OFFICIAL CAPACITY AS SECRETARY, DEFENDANT.



The opinion of the court was delivered by: Christina A. Snyder United States District Judge

FINDINGS OF FACT AND CONCLUSIONS OF LAW

FINDINGS OF FACT

1. A & K Medical Supplies ("A&K") provides durable medical equipment ("DME") to Medicare beneficiaries. (A.R. at 48.)

2. A&K submitted to Medicare carrier, Noridian Administrative Services ("Noridian"), claims for DME that were provided to 34 Medicare beneficiaries between October 24, 2005 and October 7, 2006. Id.

3. Noridian initially paid these claims in full but later determined that there was an overpayment. Id.

4. In response to A&K's request for reconsideration, Noridian issued redetermination decisions adverse to A&K on all 34 claims. (A.R. at 167-409.)

5. A&K submitted a request for reconsideration to River Trust Solutions, a DME Qualified Independent Contractor ("QIC"). (A.R. at 114-19.)

6. The QIC affirmed Noridian's decisions. Id. 7. On October 20, 2009, A&K submitted a request for hearing before an Administrative Law Judge ("ALJ"), contesting the QIC's decision. (A.R. at 112.)

8. After conducting a hearing, the ALJ issued a decision on April 9, 2010, finding that Medicare would not cover the services rendered, that the overpayment was properly issued, and that A&K was liable for the overpayment. (A.R. at 47-60.)

9. On June 25, 2010, the Medicare Appeals Council ("MAC") received from A&K a request for review of the ALJ's decision. (A.R. at 23.)

10. On October 7, 2010, the MAC dismissed this request as untimely, pursuant to 42 C.F.R. § 405.1102, and found there was not good cause to extend the time for filing. (A.R. at 18-20.)

11. On October 19, 2010, the MAC received a letter from A&K requesting that it vacate its dismissal on the basis that A&K had good cause for the untimely filing. (A.R. at 10.)

12. The MAC responded that it had denied A&K's request for review because A&K had failed to offer any explanation for the delay. (A.R. at 8.)

13. A&K then submitted another letter to the MAC, requesting a telephonic hearing regarding its request to vacate ...


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