Medicaid Providers Beware: Failure to Appeal Audit Results or Pay Medicaid Overpayments May Result in Termination of License

Wednesday, February 27, 2013

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Our firm has been consulted recently by owners of different health care entities, including assisted living facilities (ALFs), group homes, home health agencies and even medical groups that had received Medicaid overpayment demands.  Instead of requesting a formal administrative hearing to contest the overpayment assessment, they had failed to respond or only requested an informal hearing. This resulted in a Medicaid overpayment assessment.  These providers then took no further action to repay the amount assessed to Medicaid or otherwise make arrangements for a payment plan.  What followed next was a letter notifying the entity that its participation in the Medicaid program was also being terminated.

Termination from the Medicaid Program can have Devastating and Far-reaching Effects.

What many licensed health care entities and their owners fail to understand is that if their participation in the Medicaid program is terminated for cause, that is grounds for revocation of the entity's license.  Furthermore, termination of the entity's license or Medicaid provider status may also be grounds for revocation of the individual owner's professional license.

Immediately Consult with an Experienced Board Certified Health Law Attorney.

Such legal matters have a way of cascading and having many unforeseen adverse effects on health care professionals.  It is crucial that a health care professional or the owner of a health care entity immediately consult with an experienced board certified health law attorney at the first notice of an audit, investigation or other legal proceeding.  A list of Florida board certified health law attorneys can be found on The Florida Bar’s website.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don't wait until it's too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.  Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at


As a health care entity owner, have you ever received a Medicaid overpayment demand? What did you do? Please leave any thoughtful comments below.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Tag Words: assisted living facilities, group homes, home health agencies, medical groups, Medicaid, Medicaid program, Medicaid overpayment, Medicaid overpayment demands, Medicaid audit, Medicaid audit appeal, administrative hearing, informal hearing, exclusion from Medicaid, revocation, professional license, licensure issues, health law attorney , health law lawyer, Florida health law attorney, Florida health law lawyer, defense attorney, defense lawyer, Florida Medicaid attorney, Florida Medicaid lawyer

The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
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