ahca | The Health Law Firm Blog

Are You the Target of a Medicaid Audit? Tips Health Professionals Should Be Following

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

The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), and Bureau of Medicaid Program Integrity is the Florida agency responsible for routine Medicaid audits The agency ensures that the Medicaid program was billed correctly for services by health care professionals. Those receiving the greatest amounts of Medicaid payments are also the ones most likely to be audited.

These include pediatricians, Ob/Gyns, family practice physicians, and dentists. The Medicaid audit usually requests information in a questionnaire form. It also includes a request for […]

By The Health Law Firm|2024-03-14T09:59:17-04:00November 18, 2023|Health Facilities Law Blog|

Orlando-based Assisted Living Facilities Appeal ALJ Decision, Win Case Against AHCA

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

Two related assisted living facilities (ALFs) based in Orlando won a case against the Agency for Health Care Administration (AHCA) on appeal. The First District Court of Appeal heard the case and filed an opinion in favor of the ALFs on November 30, 2011.

To view the opinion in this case, click here.

Appeals Court Dismissed Three Complaints Made by AHCA.

On appeal, the ALFs challenged a final order issued by AHCA. The amended final order revoked the ALFs’ licenses, denied their licensure renewal applications, and […]

By The Health Law Firm|2024-03-14T10:00:32-04:00June 1, 2018|Assisted Living Facilities, The Health Law Firm Blog|

Appeal Court Rules AHCA Was Justified in Withdrawing Home Health Agency’s License Application

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

The First District Court of Appeal has ruled that the Agency for Health Care Administration (AHCA) had substantial justification to withdraw a home health agency’s application for licensure in a recent case. To view the opinion, click here.

Home Health Agency Challenged AHCA’s Decision to Withdraw Application.

AHCA withdrew the home health care facility’s license application because the application allegedly contained insufficient information. The application did not provide enough information for AHCA to verify actual ownership of the facility.

The home health agency challenged AHCA’s decision. The […]

By The Health Law Firm|2024-03-14T10:00:33-04:00June 1, 2018|Assisted Living Facilities, Home health care facility, The Health Law Firm Blog|

Invoking Fifth Amendment by Applicant’s Personnel May Result in Denial of Their Application for a License

The foregoing case summary was prepared by and appeared in the DOAH case notes of the Administrative Law Section newsletter

FACTS: The Agency for Health Care Administration (“AHCA”) denied Avalon Assisted Living III’s (“Avalon III”) application for licensure of an assisted living facility in Orlando. Avalon III challenged the denial, and the case was referred to DOAH for a formal hearing. During AHCA’s attempts to obtain discovery, two people closely associated with Avalon III (Mr. Robert Walker and Mrs. Chiqquittia Carter-Walker) invoked their Fifth Amendment privilege against selfincrimination in response to questions regarding the grounds stated by AHCA in its initial decision to deny the license. These areas of inquiry included alleged unlicensed activity, the ownership and control of Avalon III, […]

By The Health Law Firm|2024-03-14T10:00:54-04:00June 1, 2018|Administrative law, Assisted Living Facilities, Licensing issues, The Health Law Firm Blog|

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 Dr. Rao that he had been overpaid by the Medicaid program by $110,712.09 for services provided during the audit period. Dr. Rao’s administrative hearing challenging AHCA’s overpayment determination was pending before DOAH. On August 17, 2012, Dr. Rao filed an unadopted rule challenge, alleging that AHCA’s overpayment determination was based on unadopted rules regarding the medical necessity of long-term monitored electroencephalograms (LTM EEGs).

OUTCOME: […]

By The Health Law Firm|2024-03-14T10:00:55-04:00June 1, 2018|Administrative law, Assisted Living Facilities, Medicaid, Medicaid audit, The Health Law Firm Blog|

Governor Requests the Agency for Health Care Administration to Inspect Florida’s VA Hospitals

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

In response to recent deaths at Veterans Affairs (VA) hospitals throughout Florida and the rest of the nation, on April 1, 2014, Governor Rick Scott wrote a letter to the Florida Agency for Health Care Administration (AHCA) requesting the agency begin inspecting VA hospitals in the Sunshine Health Network. This network under investigation includes Florida, south Georgia, Puerto Rico and the U.S. Virgin Islands. So far the VA has denied AHCA any permission to inspect its hospitals, and it is unclear whether the federal government will allow such inspections moving forward.

To see a copy […]

By The Health Law Firm|2024-03-14T10:00:56-04:00June 1, 2018|The Health Law Firm Blog, VA, Veterans Administration physician representation|

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 Program Integrity (MPI), will conduct site visits to determine compliance with the Florida Medicaid Provider General Handbook and the Assistive Care Services Coverage and Limitations Handbook. This is just one of several initiatives aimed at ALFs to curtail fraud, waste, and abuse in the Florida Medicaid program.

Be Prepared.

The goal of a site visit is to determine if providers […]

By The Health Law Firm|2024-03-14T10:00:58-04:00June 1, 2018|Assisted Living Facilities, Medicaid, Medicaid audit, Office of Inspector General, The Health Law Firm Blog|

Are You Working at an Illegal Health Care Clinic?

Despite the passage of Florida’s Health Care Clinic Act over nine years ago, there are apparently still many health practices which are violating it. Unfortunately, the violation of the Health Care Clinic Act can have extremely serious repercussions, including conviction of a felony, loss of all fees collected, and disciplinary/licensure action against any physicians, nurses or other licensed health professionals working there.

Over the past three years we have seen the following scenarios or ones similar to these (changed factually to ensure anonymity):

Scenario 1: A physician licensed in Florida decides to sell her practice and retire. Three non-licensed business people decide to form a corporation to purchase and operate the practice. The corporation purchases the […]

By The Health Law Firm|2024-03-14T10:00:29-04:00June 1, 2018|Health Care Industry, The Health Law Firm Blog|

Assisted Living Facilities (ALFs) Allowed to Terminate a Resident For Almost Any Reason

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

Currently, Florida law and regulations allow an assisted living facility (ALF) to relocate or terminate a resident for almost any reason. However, the administrator must provide a 45-day notice and document the reason for termination or relocation.

Section 429.28(k), Florida Statutes (2011), states that an ALF resident must receive:

At least 45 days’ notice of relocation or termination of residency from the facility unless, for medical reasons, the resident is certified by a physician to require an emergency relocation to a facility providing a more skilled level of care or the […]

By The Health Law Firm|2024-03-14T10:00:32-04:00June 1, 2018|Assisted Living Facilities, The Health Law Firm Blog|

Florida Medicaid Audits Dental Claims

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

The Agency for Health Care Administration (AHCA) is auditing Medicaid claims submitted by dental providers in Florida. AHCA is auditing dental practices looking for claims that were not billed in compliance with the Florida Medicaid Dental Services Coverage and Limitations Handbook. AHCA’s audits are focused on claims that are billed too frequently, claims that are billed on the same date of service as a redundant code, and claims that have been unbundled when they should have been billed as part of a comprehensive code.

Specific Dental Codes Being Audited.

Dental providers that are the subject of these audits may […]

By The Health Law Firm|2024-03-14T10:01:44-04:00May 15, 2018|Dental Law, Dentist Defense attorney, Dentistry Law, Dentists|