Be Prepared for a Medicaid Audit Request
By Lance O. Leider, J.D., M.P.A., LL.M., Board Certified by the Florida Bar in Health Law Florida healthcare providers servicing Medicaid patients are at a higher risk for audits than anywhere else in the country. The reason is that Florida has become synonymous with healthcare fraud. As a result, auditing and subsequent overpayment demands are some […]
Physician Argues Definition of “Peer” at Formal Administrative Hearing
FACTS: The Agency for Health Care Administration (“AHCA”) is responsible for administering Florida’s Medicaid program and conducting investigations and audits of paid claims to ascertain if Medicaid providers have been overpaid. With regard to investigations of physicians, section 409.9131, Florida Statutes, provides that AHCA must have a “peer” evaluate Medicaid claims before the initiation of formal […]
A New Year Means New Audits and Site Visits for Assisted Living Facilities – Protect Yourself Now
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law For Assisted Living Facilities (ALFs) in Florida, it’s time to do a little brushing up on your compliance material. Beginning in January 2015, the Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), Bureau of Medicaid […]
Internal Medicine Specialists Should Be Aware of Impending Medicare Audits
Coming to a medical practice near you. . . It’s scary, it’s horrible, and it could cost you a lot of money! It’s the dreaded Comprehensive Error Rate Testing (CERT) audit. The Horror! The Horror! First Coast Service Options, the Medicare contractor for Florida, announced a new prepayment audit program that will impact Internal Medicine […]
OIG Audit Finds Federal Database of Terminated Medicaid Providers Needs Improvement
By Lenis L. Archer, J.D., M.P.H., The Health Law Firm The Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) to establish a process for sharing information about terminated Medicaid providers. The federal database, called Medicaid and Children’s Health Insurance Program State Information Sharing System (MCSIS), is designed to prevent terminated […]
AHCA Expert Not Allowed to “Use His Discretion” in Deciding Claims Were Improper in Medicaid Appeal Hearing
FACTS: The Agency for Health Care Administration’s (“AHCA”) Office of Medicaid Program Integrity audited Dr. Rao, an authorized provider of Medicaid services, for claims between July 1, 2007, and June 30, 2009, and found him to be in violation of certain Medicaid provider policies. AHCA prepared a Final Audit Letter on June 1, 2011, notifying […]
Florida Nursing Home Owner Arrested for Alleged $395,000 Medicaid Fraud Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Miami-Dade nursing home owner was arrested for allegedly committing $395,000 worth of Medicaid fraud. The Florida Attorney General (AG) accused the nursing home owner of using the billing names of non-existent businesses to submit fraudulent invoices. The […]
Medicaid Fraud Control Unit Arrests Three Florida Women for Allegedly Bilking Medicaid Out of $27,000
By Lance Leider, J.D., The Health Law Firm Three Central Florida women were arrested by the Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU) on July 18, 2013, for allegedly defrauding Medicaid out of $27,000. According to the AG, the owner and two managers of Destiny TCM Corporation are accused of billing Medicaid for services […]
Cardiologists Face Higher Scrutiny by CMS
By Lance O. Leider, J.D., The Health Law Firm As the U.S. population ages and heart disease continues to be a leading cause of health issues, cardiologists and cardiology practices are finding themselves billing Medicare for more and more visits and procedures. Along with that increase in reimbursement from Medicare comes an increase in scrutiny. […]
Speech Therapist Arrested for Billing Medicaid $500,000 for Work at Florida Day Care Centers While Living in Illinois
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A speech therapist was arrested on March 29, 2013, for allegedly billing Medicaid more than $500,000 for services that she did not provide, according to the Florida Office of the Attorney General (AG). The speech therapist now faces […]
Tips for Responding to a Medicaid Audit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Should you find yourself, your facility or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know. The most important thing is that […]
Zone 4 Program Integrity Contractor (ZPIC) for Medicare and Medicaid Programs is Health Integrity, LCC
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Health Integrity, LCC, was named the Zone 4 Program Integrity Contractor (ZPIC) for the Medicare and Medicaid programs. As the ZPIC for Zone 4, Health Integrity has been performing benefit integrity activities aimed to reduce fraud, waste and […]
You Must Challenge Overpayment Demands from Medicare and Medicaid Audits
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We have recently received numerous communications from health care professionals, including physicians, physical therapists, occupational therapists, mental health counselors, durable medical equipment (DME) providers, assisted living facilities (ALFs), group homes, and psychologists, who have been placed on prepayment […]
Florida Woman Arrested for $400,000 Medicaid Fraud Scheme
By Lance O. Leider, J.D., The Health Law Firm The owner of Homecare Unlimited, LLC, in Jacksonville, Florida, has allegedly been arrested for defrauding Medicaid out of more than $400,000, according to the Florida Office of the Attorney General (AG). The owner is charged with billing Florida’s Aged and Disabled Adult Waiver Program for services […]
Power Wheelchair Suppliers Voice Concerns over New Government Program
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On September 19, 2012, power wheelchair suppliers voiced their concerns over a new government program called the Power Mobility Devices (PMDs) Demonstration at a Senate Special Committee on Aging. Durable Medical Equipment Suppliers (DMES) protested the program because […]
Palm Beach Speech Pathologist Arrested for Alleged Medicaid Fraud
By Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm A Palm Beach, Florida, speech pathologist has allegedly been charged with Medicaid fraud and grand theft by the Attorney General’s (AG) Office of Statewide Prosecution. According to the press release posted on June 29, 2012, from the AG’s office, the speech pathologists is accused […]
Whistleblower Lawsuit Alleges Florida Adventist Hospitals Overbilled Millions of Dollars
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A whistleblower lawsuit based on information from a former Florida Hospital Orlando billing employee and a former staff physician alleges that seven of Adventist’s Florida hospitals overbilled the federal government between 1995 and 2009, resulting in tens of […]
How to Respond to a Medicaid Fraud Control Unit (MFCU) Investigative Subpoena
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Christopher E. Brown, J.D. The Medicaid Fraud Control Unit (MFCU) is a division of the Florida Office of Attorney General. It is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid […]
August 27, 2012, Marks the Start Date of the CMS Recovery Audit Prepayment Review (RAPR)
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 31, 2012, the Centers for Medicare and Medicaid Services (CMS) announced on its website that hospitals should brace themselves for prepayment audits beginning August 27, 2012. The CMS originally announced the Recovery Audit Prepayment Review (RAPR) […]
Two Owners of Florida Counseling Center Arrested for Allegedly Defrauding Medicaid Out of $80,000
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The two owners of a Minneola, Florida, ministry that helps provide counseling therapy and case management for children and families, each face up to 15 years in prison for allegedly defrauding Medicaid. According to the Florida Attorney General […]
Medicare and Medicaid Audits of Psychologists and Other Mental Health Professionals – Part 2
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals. I have recently seen a number of audits initiated against psychologists and mental health […]
Woman Admits to Defrauding Medicaid For Fake Mental and Behavior Health Services
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A North Carolina woman pleaded guilty on September 14, 2012, for her involvement in a health care scheme that allegedly defrauded Medicaid from 2008 to 2011 for fake mental and behavior health services. Through this scheme, she allegedly […]
Central Florida Mental Health Counselor Accused of Heading Up $3 Million Medicaid Fraud Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law A registered mental-health counselor is accused of running a $3 million Medicaid scheme through the mental health facility she owned, according to the […]
New Mexico’s Largest Mental Health Providers Accused of Defrauding Medicaid Out of $36 Million
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law For months now, 15 New Mexico behavioral health agencies have been the subject of a Medicaid fraud investigation. The state’s largest mental health providers had their Medicaid funding frozen by the New Mexico Human Services Department (HSD) due […]
Mother and Daughter-In-Law Arrested for Allegedly Defrauding Medicaid Out of More Than $70,000
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A mother and daughter-in-law duo each face up to 30 years in prison for allegedly defrauding the Florida Medicaid program out of more than $70,000. According to a press release from the Florida Attorney General (AG), released February […]