Jonathan D. Schuman

I am a former attorney, with the Office of General Counsel, Medicare Part B, Baltimore Central Office, some experience out of law school in defense of doctors and insurance companies. Now I do both depends upon the issue but I handle no malpractice cases myself or any PI cases but know some top lawyers to suggest to you.

I do not know much about state law or family law, traffic laws, divorce law, contracts, criminal law etc. I ONLY know something about Medicare Medical Necessity and how much money physicians should be legally allowed to bill you,or how much private insurance allows doctors to bill you. 

I also kow a little bit about pursuing your legal rights if you think that you have been discharged by your doctor from a hospital or a nursing home and you want to contest that denial.

By analogy you want to purchase a new VW. You agree on the price to purchase the car and you had an itemized list of dealer added specials. When you get the car you are charged $4000 more for the front door. You say to the dealer, "I thought the front door came with the car," I did not know you could charge separate for it"?  In legal terms called unbundling, or fragmenting is what the dealer did to you, and some physicians do the same thing. 

 This happens a lot in aesthetic surgery when done with a covered procedure. It also happens a lot to cash patients who may be charged more for a medical procedure than others wo have insurance or Medicare.

I can also help physicians correctly document the Medicare and or private insurance medical necessity for the items and services claimed for. How to document to comply with the CPT code claimed is a legal determination not a medical one .What is a medically necessary item or service is a legal decision of which the documentation in the charts is simply evidence of what item or service was rendered.