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CLIENT ALERT: Medicare Trust Fund to Run Out of Funding Beginning in 2026, Likely to See an Increase in Audits, Overpayment Demands and Extrapolations

Client Alert

Pursuant to a Medicare Trustee Report released on June 5, 2018, the Medicare trust fund will run out of funding beginning in 2026, which is three years earlier than previously expected.  Although the Trustee’s report requests that Congress and the President act with urgency to remedy this problem, in the short term, we expect to see an increase in government payer audits, overpayment demands, and extrapolations.

 

If implemented in full strength, these overpayment demands and extrapolations can result in payers recovering millions of dollars from providers, which may be returned to the trust fund.  In the alternative, payers and their contractors may allege overpayments so that providers agree to a settlement requesting the provider to accept pennies on the dollar for the true amount owed to the provider.

 

Either way, it is now more crucial than ever before that providers take action when government payers and their contractors seek to conduct pre- and post-payment audits and otherwise seek the refund of overpayments.

 

BMD’s Healthcare Department can meet with you to discuss your options if your practice is facing pre- and/or post-payment audits and denials.  If you are subjected to an overpayment, including an extrapolation, our experienced team can strategize your appeal and arguments for success in challenging the overpayment allegations.

 

If you have any questions concerning payer audits, appeals, overpayments, and extrapolations, or the administrative appeal process in general, please contact  Amanda L. Waesch, Esq. (alwaesch@bmdllc.com) or Bryan E. Meek, Esq. (bmeek@bmdllc.com), attorneys in Brennan, Manna & Diamond’s Provider Relations, Audits, Appeals, and Negotiations Unit, a division of BMD’s Healthcare Department.

 


Supreme Court Eliminates Higher Burden for Majority-Group Plaintiffs in Title VII Claims

In Ames v. Ohio Department of Youth Services, the U.S. Supreme Court unanimously ruled that all Title VII plaintiffs, whether from majority or minority groups, must meet the same evidentiary standard. The decision eliminates the “background circumstances rule” and reinforces equal treatment in workplace discrimination claims.

Blue Cross Blue Shield Provider Settlement Opportunity

A proposed $2.8 billion settlement in the Blue Cross Blue Shield Antitrust Litigation may offer payments to eligible healthcare providers who delivered services between July 24, 2008 and October 4, 2024. Claims must be submitted by July 29, 2025.

Understanding Reasonable Fear vs. Credible Fear Interviews: A Critical Guide for Immigrants Facing Removal

In his latest article, Immigration Attorney and former Immigration Judge Rob Ratliff offers a clear breakdown of Reasonable Fear vs. Credible Fear Interviews—key procedures for noncitizens seeking protection from persecution or torture. Citing Judge Brian Murphy’s recent ruling on unlawful deportations to South Sudan, Ratliff connects these critical legal standards to current judicial developments. Read the full article at www.removal-defense.com.

House Republicans Propose Cuts to Medicaid to Finance Savings

House Republicans have introduced legislative language that proposes substantial cuts to the Medicaid entitlement program, aiming to achieve significant budget savings through policy changes. The proposed measures include stricter eligibility verification, work requirements for certain adults, and federal funding cuts to states providing coverage to undocumented residents. The Congressional Budget Office (CBO) estimates that the proposed healthcare provisions would reduce spending by $715 billion and could result in 8.6 million fewer people having health insurance by 2034.

Protecting Your Image in the Age of AI-Generated “Deepfakes”

The rapid evolution of artificial intelligence (AI) has transformed how we create and consume digital content, but it also poses significant risks. Among the most troubling developments in AI is the proliferation of AI-generated fraudulent content, often called “deepfakes”.