HHS OIG Release of New “General Compliance Program Guidance” Provides Valuable Insight on Prevention of Health Care Fraud, Waste, and Abuse

By Michelle E. Missigman, J.D.
On November 6, 2023, the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG), released 91 pages of “General Compliance Program Guidance” (GCPG) on its website.  This is the first compliance program guidance the OIG has released since 2008.  The GCPG provides general compliance guidance, tools, and references for use by federal health care program providers.
This new guidance brings together many resources and links, making it a valuable and easy-to-read tool to keep on hand for any professional working within the healthcare industry.
The GCPG covers the following topics:
I.  Introduction
The GCPG  provides a thorough introduction to the OIG’s history and commitment to preventing health care fraud an abuse.  It provides a roadmap for how the OIG intends to modernize and improve its publicly available resources.  The OIG’s goal is to continue producing these resources, deliver information to the public in a user-friendly approach using modern technology, and produce informative and useful resources to help advance the health care industry’s compliance efforts in preventing fraud, waste, and abuse.
II.  Health Care Fraud Enforcement
The GCPG provides a broad overview of federal healthcare fraud enforcement standards and laws,  such as: the anti-kickback statute, physician self-referral law, false claims act, civil monetary penalties, exclusions from federal programs, criminal health care fraud statute, HIPAA privacy and security rules.
III.  Seven Elements of a Successful Compliance Program
The largest section of the GCPG reinforces and provides a thorough explanation of the seven elements of an effective compliance program:
1.  Written Policies and Procedures
2.  Compliance Leadership and Oversight
3.  Training and Education
4.  Effective Lines of Communication with the Compliance Officer and Disclosure Programs
5.  Enforcing Standards: Consequences and Incentives
6.  Risk Assessment, Auditing, and Monitoring
7.Responding to Detected Offenses and Developing Corrective Action Initiatives
Much of the guidance in this section reflects the OIG’s prior guidance in monitoring Corporate Integrity Agreements (CIAs).  Check out this article on CIAs.
IV.  Compliance Program Adaptations for Small and Large Entities
Maintaining an effective compliance program can be burdensome for smaller entities that have limited resources.  The OIG acknowledges this and provides guidance on how smaller entities can still implement a compliance program that meets the above seven elements of a compliance program.
For larger entities with more resources, the GCPG goes into detail about the compliance officer’s role within the organization.  The compliance officer should have the authority to oversee and direct the organization’s compliance function and lead the compliance department. The organization’s board of directors and compliance office should meet periodically to evaluate the compliance department and determine whether it meets the needs of the organization.
V.  Other Compliance Considerations
The GCPG considers other areas to assist entities in developing policies and procedures to reduce or eliminate potential fraud and abuse risks.  Some other areas they have considered are: quality and patient safety, new entrants in the health care industry (e.g. technology companies, new investors, and non-traditional services in health care such as social services, food delivery, and care coordination services), financial incentives, and financial arrangements.
VI.  Additional OIG Resources and Tools

Lastly, the CPCG lists links all of the resources available on the OIG website, including previous compliance program guidance, advisory opinions, special fraud alerts, safe harbor regulations, compliance toolkits, OIG reports and publications, corporate integrity agreements, self-disclosure information and access to OIG’s hotline. The OIG has even implemented a FAQ process to provide informal feedback to the health care community.
Contact Health Law Attorneys Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program and Assisting in Reinstatement Applications.
The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).
To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the Author: Michelle E. Missigman, is a health attorney practicing with The Health Law Firm.  The firm has a national practice.  Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
Sources:
“Criteria for Implementing Section 1128(b)(7) Exclusion Authority.” U.S. Department of Health and Human Services Office of Inspector General. (2016). Web.
Dani Kass. “HHS Watchdog Lays Out New Grounds For Exclusion List.” Law360. (2016). Web.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 The Health Law Firm. All rights reserved.

Florida Dentist Convicted of First-Degree Murder of Florida Statue University Law Professor

Attorney & Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On November 6, 2023, a jury convicted a South Florida dentist of conspiracy to commit murder, solicitation of murder, and first-degree murder in the killing of his former brother-in-law. After more than three hours of deliberations, the jury delivered the verdict in the Second Judicial Circuit Court in Tallahassee, Florida.

The Relationship Between the Dentist and the Professor.

The Florida dentist’s sister was previously married to the Florida State University (FSU) Law professor. The couple separated in 2012 and divorced in 2013.

The couple battled in divorce court and for custody of their two children. The proceedings were very contentious. They argued over every detail of their children’s lives. The parents had 50/50 custody, and there was a court order that prevented the ex-wife from moving away.

The prosecution argued that the ex-wife’s family was desperate to get her and the children to move back to South Florida.

The Schemes For Relocation.

The ex-wife’s family allegedly concocted schemes that would allow the wife and children to move closer to them in South Florida.

One reported scheme was to convince the FSU Law professor to move to South Florida with the children by paying him $1,000,000. The ex-wife’s parents allegedly agreed to split the payment of the million dollars with the brother, the dentist. The ex-wife’s mother allegedly also told the dentist to threaten the devoutly Jewish father that they would enroll the children in a Catholic private school if he did not relocate to South Florida. Unfortunately for the FSU professor, the scheme that would ultimately occur was a murder-for-hire.

The Murder-For-Hire.

The dentist was then dating a woman who had connections to a criminal gang in North Miami. The dentist’s girlfriend testified against him, stating that the dentist first asked her about connecting him with a hit man in October 2013. She also said that he pressured her to move forward with the murder-for-hire in June and July 2014.

Two men were hired to execute the hit on the FSU Law professor. One was the father of the dentist’s girlfriend’s children, and the other was a gang leader in Miami.

The gang leader took a plea deal concerning the murder-for-hire. He is serving 19 years concurrent with a federal racketeering charge he previously served. He testified in the dentist’s trial. He said that he and his accomplice drove to Tallahassee and stalked the professor on July 18, 2014. When the professor returned to his home, the accomplice shot him twice. The professor was transported to the hospital after a neighbor called 911 but he died the next day in the hospital.

The gang leader testified that the dentist paid $100,000 for the hit men to kill the FSU Law professor. The payment was split between the gang leader, the accomplice and triggerman, and the girlfriend.

The girlfriend was sentenced to life in prison in 2022 for her involvement in the murder. In 2019, the triggerman was also sentenced to life in prison for his role in the killing of the professor. The gang leader is serving 19 years in prison for his involvement in the murder.

The Trial.

In his defense, the dentist testified that he played no role in the murder-for-hire. He claimed that he was the victim of an elaborate extortion scheme masterminded by the girlfriend.

The prosecution argued that the dentist and his family were so desperate to have the sister and her children back in South Florida that the dentist masterminded a murder-for-hire scheme.

After only approximately three hours of deliberation, the jury returned a guilty verdict to each charge: conspiracy to commit murder, solicitation of murder, and first-degree murder.

It is expected that the dentist will also lose his license to practice dentistry as a result of the conviction.

Contact Health Law Attorneys Experienced with Investigations of Dentists and Health Professionals Today.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, nurses, nurse practitioners, CRNAs, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Bridges, C. A. “FSU professor Dan Markel’s killing: Everything to know about the murder-for-hire case.” Tallahassee Democrat. (25 October 2023) https://www.tallahassee.com/story/news/local/2023/10/25/dan-markel-florida-murder-case-brother-in-law-charlie-adelson-tallahassee-homicide-trial/71298187007/

Burlew, Jeff. “Man found guilty of murdering FSU law professor Dan Markel.” FSU News. (7 November 2023) https://www.fsunews.com/story/news/2023/11/07/man-found-guilty-of-murdering-fsu-law-professor-dan-markel/71487542007/

Royal, Denise. “Man charged in murder-for-hire of FSU law professor convicted on all counts.” CNN. (7 November 2023) https://www.cnn.com/2023/11/07/us/fsu-professor-charles-adelson-murder-conviction/index.html

Minksy, David. “Dentist Found Guilty of Murdering Fla. Law Professor.” Law360. (6 November 2023) https://www.law360.com/articles/1751533/dentist-found-guilty-of-murdering-fla-law-professor-

About the Authors: 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. Hartley Brooks is a law clerk with The Health Law Firm. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or toll-free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024. George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be published or used in any medium for any purpose without the copyright owner’s written permission. The copyright owner/creator reserves the right to have his name associated with all parts of this work.

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

Headshot of Attorney George F. Indest IIIBy 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 copies of medical records (including X-rays and other diagnostic studies) for the patients selected for the audit.

If AHCA determines that Medicaid overpaid for services, it will use a complex mathematical extrapolation formula to determine the repayment amount. Additionally, fines and penalties can be added by the Medicaid program. However, you can eliminate or reduce the amount of any such repayment by actions taken both before and during the Medicaid audit.

Practical Tips for Your Practice.

There are ways to run the everyday practice that will help you if you are selected for a Medicaid audit.
1. Every patient record entry should be clearly dated and signed or initialed by the provider. Make sure this is always done.

2. When documenting the patient’s record, make sure that you document exactly what services were needed and completed to support what was billed to Medicaid.

3. Communicate with the person responsible for your billing so that the actual services provided are billed for. Do not bill in advance for anticipated services needed as indicated in the appointment calendar or on a treatment plan.

4. Keep the patient records organized and ready for copying, if necessary. Using only one-sided documents and securely fastening small forms (prescriptions, telephone memos, small sticky notes) onto 8-1/2″ by 11″ paper will help those still using paper charts. Scan all such documents into the patient record using an electronic health record (EHR).

5. Services provided by a physician not enrolled in the Medicaid program to a Medicaid patient may not be billed to or paid by the Medicaid program. Therefore, never allow any other physician associated with your practice who is not enrolled as a Medicaid provider to provide services to Medicaid patients. Do not allow a new physician coming into your practice to treat Medicaid patients until he or she actually has received his or her Medicaid provider number. The group may not bill for the services, nor may another physician bill for the services.

6. Ensure that all health care professionals’ licenses and permits are updated. Ensure that all X-rays, clinical lab, and diagnostic equipment are permitted and kept up to date. Ensure that any CLIA license or exemption certificate is correct and kept up to date. Services billed by unlicensed personnel or services provided by improperly-licensed facilities may not be paid by the Medicaid program.

7. Use only standard abbreviations in your medical records documentation, orders, and reports. While an abbreviation may seem familiar to you or your practice, the auditors may not recognize it if it is not a universally accepted abbreviation.

8. Make sure all records are timely made, accurate and legible. Safeguard them, and never let the original leave your office. Illegible records are treated as a non-record, and payment is wholly disallowed for an illegible note or order. A missing record, X-ray, or chart entry will result in a complete repayment being directed for those services.


The Medicaid Audit.

If you are on the receiving end of an audit, AHCA will send you a letter notifying you. AHCA will also supply you with a list of patients to be sampled. A standard sample will include a list of anywhere from 30 to 150 patient names, as a general rule, depending on the size of the practice. Regular audits routinely request 30 to 50 patients’ records. The audit letter will also include a questionnaire to be completed (Medicaid Provider Questionnaire) and a “Certification of Completeness of Records” form to complete and return with the copies of the patient records. (Please note: This will be used against you in the future if you attempt to add or supplement the copies of the records you provided.)

For more information, read a past blog that will let you know if you are the subject of an audit.

You must retain the services of an expert consultant or experienced health care attorney to correctly and accurately complete the questionnaire. The letter will also request that you provide copies of the patient records for the list of patients included with the letter. You will only be given a short time to provide these documents.

If you have been accused of Medicaid fraud and need to prepare for an audit, watch our informational video blog.

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 law 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 www.TheHealthLawFirm.com.

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. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“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.
Copyright © 2018 The Health Law Firm. All rights reserved.

Helpful Tips Healthcare Professionals Should Be Following for Professional Correspondence

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

I review many letters, e-mails, memoranda, and other types of correspondence prepared by my physician and nurse clients during my legal representation. These come to me often because of a dispute with a hospital, their peers, an insurance company, a lawsuit filed by a patient, a complaint being investigated by the licensing agency, an investigation of an incident, or another serious matter.

In many cases, way too many cases, such correspondence is unprofessional and defeats the purpose of the reason you are sending the correspondence. Sometimes the “letter” is so bad, that it will be disregarded by the reader to whom it was directed. I have seen this from doctors, nurses, dentists, psychologists, owners of health care businesses, and many, many other highly educated professionals who really should know better.

When I receive a “letter” that has no return address on it, no date on it is not addressed to a person or organization, has typographical errors and misspellings, does not have a paragraph, or is not signed, I cringe.

When such documents are dictated and transcribed by a professional medical transcriptionist, they are usually properly formatted and many of the errors I note below are avoided. However, when the health professional types (or word-processes) his or her own document or, worse yet, hand writes it, this is when I see the most errors.

To avoid these errors that make your correspondence and written communications look unprofessional, follow these tips.

Remember Why You Are Writing.

Remember, the basic purpose of your correspondence is to communicate ideas effectively. In many cases, it will be to invoke your legal rights in certain situations (such as an appeal or a hearing request). Sometimes, it will attempt to persuade your hospital, peers, or employer to take a certain action or refrain from a certain action. Remember that your correspondence is often the first impression that the other side will have of you. Do you want it to be an impression that you are sloppy, lazy, unprofessional, not knowledgeable, uneducated, or confused?

Whether you are communicating in a letter or via e-mail, these rules still hold true. In many (if not all) situations involving legal proceedings or legal issues, it is probably best to communicate via a letter sent by U.S. mail or some other reliable delivery service (e.g., Federal Express, Airborne Express, DHL, etc.). Even if you are transmitting your information via e-mail, it is my suggestion to prepare it in the form of a paper letter (if your e-mail is not set up to insert your letterhead and signature block automatically) and then scans it in and send it electronically.

I discourage legal communications via e-mail in serious matters because e-mails are often difficult to obtain, isolate, and authenticate when you need them for hearings. Additionally, they are rarely secure, often available to many others who shouldn’t see them, and easily susceptible to being accidentally sent to others who should not see them at all.

Horror Stories of Unprofessional Correspondence.

Why do I feel this article is necessary? Because of all the truly horrible correspondence I have seen written by allegedly highly educated professionals, mostly physicians and nurses. That’s why!

True “Horror Stories” About Unprofessional Correspondence

Here are just a few examples of true “horror stories” regarding unprofessional correspondence:

The physician never wrote a separate response to any charges or allegations made against him after receiving letters from the Medical Staff advising him he was under investigation. He would just hand write (scribble, actually) his remarks on the bottoms and in the margins of whatever document was sent to him and then send it back.

A nurse practitioner was required to respond to serious negligence charges, resulting in an adverse outcome for a patient. On unlined paper, she hand-wrote a response letter that was not addressed to anyone, not dated, not signed, and did not state who was sending it. There was no name or signature on it.

A physician was required to provide his analysis of a patient’s case for peer review purposes within the hospital. His typed letter of three full pages, single-spaced, contained one long paragraph. I used to work for a Medical Corps Admiral when I was a Navy JAG Corps officer. The Admiral, a very educated and proper professional, would just glance at such correspondence and state: “I can tell this doctor doesn’t have any idea what he is talking about.” Failing to follow good correspondence procedures will show others your thoughts lack organization and cohesion. A document that lacks organization reflects a mind that lacks organization.

A health professional was required to complete an application for clinical privileges. He wrote all of the answers by hand, not even staying within the lines on the form, writing over the questions printed on the form and around in the margins of the application. This is what he signed and turned in to the credentials committee at the hospital. Believe me, this did not look very professional.

A physician was requested to respond to a medical staff inquiry from the hospital. Her response came back typed (actually word-processed) in a type font that was 22 characters per inch (cpi), almost too small to read. Perhaps she was just trying to save a sheet of paper. But many of us would have had to pull out a magnifying glass or put on reading glasses in order to be able to read it. Once it is scanned or faxed and then photocopied or re-scanned and re-faxed several times, it will be completely illegible. If you are actually trying to communicate your ideas, make your correspondence easier to read, not harder to read. This is my cardinal rule.

A dentist was notified of a pending complaint investigation being opened against her dental license. She wrote her response to the charges back to the investigator, without using any business address or title, and began her response statement with “Dear Sharon,”. Do not treat others informally, especially in professional or formal situations. You will be deemed to be unprofessional when you do so. The investigator is not your friend, your sister, or your mommy. Do not address her by her first name. Do not end the salutation with a comma, like you would a love letter. End it with a colon like you would a professional business letter.

30 Tips for Good Professional Correspondence.

Here are some pointers on professional communications that should be followed in all of your professional written communications about business, professional or legal matters, even in e-mails. Please note, that the terms below in quotation marks have certain defined meanings. If you don’t know what these terms mean, look them up.

1. Always remember that the reason you are sending the correspondence is to attempt to effectively and accurately communicate your position and ideas. If you are trying to make your message indecipherable or difficult to understand, ignore these tips. If you are trying to come across as someone who doesn’t give a damn about how he or she is perceived, ignore these tips. If you want to come across as unprofessional, ignore these tips.

2. Make sure you include your complete and correct “return address” and contact information if you are not using your own letterhead. This includes your physical or mailing address, telephone number, telefax number and e-mail address, so that the other party knows exactly how to reach you. In cases where you already have this on your letterhead, be sure to use your letterhead (but only your own). Also, it appears more professional to create a letterhead with the information in it and to use your new letterhead instead of having a professional business letter with a typed “return address.” However, a typed “return address” is better than none.

3. Don’t use someone else’s letterhead. Don’t use your hospital, medical group or institutional letterhead for your own personal communications, unless you are the owner. Use your personal letterhead (see above), instead. If you are being accused of poor utilization review, unprofessional conduct, or personal use of hospital (or company) property, then using someone else’s letterhead just helps prove the charge against you.

4. Date your correspondence. Date your correspondence. Date your correspondence. Nothing shows a lack of professionalism and lack of attention to detail as sharply as undated correspondence. It will certainly be difficult to prove when your letter or document was sent if you do not have a date on it. A year or two later, it may be completely impossible to do so. In case I forgot to mention it, be sure to date your correspondence.

5. Use titles or honorifics. In the “business address” of your correspondence, always use the complete name of the person to whom you are writing (if known) together with that person’s honorific or professional title (e.g., Mr., Ms., Dr., Nurse, Prof., Dean, etc.) This shows both respect and professionalism.

6. Always use the complete mailing address, including the title, of the person to whom you are sending the letter. The business address of your correspondence includes not only the person’s name and honorifics but the title or position and division within the institution or organization to which you are sending it. In the case of large organizations, you should include the building and suite or room numbers and any internal routing codes, designations, “mail stops” or other organizational routing codes, that the agency or business you are writing requires to route its mail internally. Large organizations, especially government agencies and insurance companies, all have large mail rooms that sort and route all mail the organization receives from any source. Correct internal routing codes will help ensure that your correspondence gets to the correct person or official in a timely manner. Often today companies scan or have all e-mails saved by a clerk, as well

7. Always use a salutation. This is self-explanatory but see below.

8. In your “salutation,” always use the person’s last name with a title or honorific. It is customary to use the term “Dear” in a salutation in formal writing, so this is permitted. But you may leave it out. For example, “Dear Secretary Jones:” or “Secretary Jones:” or “Dear Dr. Johnson:” or “Dr. Johnson:”; all of these are correct. Never refer to the person by that person’s first name in any type of formal correspondence or correspondence that anyone else might read. Never say: “Dear Sue:” or “Sharon:”. Even if you know these people well enough to call them by their first names, don’t do it in this situation; it’s unprofessional and may be interpreted as “talking down” to the person.

9. Always end your “salutation” with a colon, not a comma. A comma is only used in informal communications to those you know well or socially, such as a letter to your mother or a note to your girlfriend. Unless this is your mother or your girlfriend to whom you are writing, use a colon. For example, “Dear Secretary Jones,” or “Dear Sue,” is incorrect. “Dear Secretary Jones:” or “Ms. Smith:” is correct.

10. Type (or word-process) your correspondence or have it typed (or word-processed) for you; this is one reason transcriptionists, secretaries and clerks have jobs. Do not send handwritten letters in formal or professional matters. Do not write on the other person’s correspondence or documents and send them back. Prepare and send a professional-looking letter or e-mail, even if you must pay someone to type it for you (and if you are sending an e-mail, I know you can type a little bit yourself, anyway). To do otherwise is to show laziness, disrespect and unprofessionalism.

11. Always use a type font in your correspondence (including e-mails) of at least 12 points (10 characters per inch). Do not use small, difficult-to-read type fonts, for example, the size of the type font that most e-mail software defaults to. Smaller type fonts than 12 points become difficult to read, especially if scanned/rescanned, faxed/refaxed, or copied/recopied. Change the default font in your e-mail software or computer word processing software, if necessary. You can do this, regardless of how difficult it may seem at first; I know you can do it because I can do it. Make your professional correspondence easier to read, not more difficult to read.

12. Never use unprofessional-looking type fonts for your communications. Stay away from script-type fonts, italics, or novelty-type fonts. These are notoriously more difficult to read and look unprofessional. You are not publishing a flyer for a high school bake sale. Times New Roman, CG Times, and similar type fonts are more professional looking and easier for a person to read. Use Courier or Letter Gothic type fonts if necessary.

13. Keep the correspondence to which you are responding unmarked. One reason to not write on or mark up the other person’s documents or correspondence is that you may need them as evidence in a court of law or a hearing someday. Nothing looks less professional than a document you are trying to use as evidence when a different person has made handwritten marks all over it. The impression is similar to one in which a child with a box of crayons has gotten to it. You don’t want this or need this. Show respect and self-control. Keep the other side’s documents pristine. They will look much better that way as your “Exhibit 1” in the court hearing.

14. Use a good concise, descriptive reference line or subject line (often called the “re:” line). Make it a very brief summary. State what the content of your letter is actually about. State if you are responding to a letter or document that you received from the “addressee” (the person to whom you are addressing your correspondence) of your letter.

15. Include the recipient’s routing information. If the intended receiver of your letter or correspondence (the “addressee”) included reference numbers, file numbers, account numbers, case name and numbers, a policy number, an investigation number, a routing number, or other similar information on its letter to you, repeat these back in the reference line of your correspondence. This will help make sure that your correspondence gets routed to the correct file and recipient more timely. This is especially crucial in large organizations and government agencies.

16. The contents of the body of your correspondence should be easy to read and easy to understand. To this end, be sure to use short sentences and short paragraphs. Each paragraph should convey one idea. Use headers and section titles, if necessary, to organize your correspondence, especially if it is lengthy. Remember, headings within your letter that help to organize it are like street signs in a busy city. They will really help any subsequent reader (and this may be a judge, a jury or a Board of Mediciney) to navigate his, her or its way through your letter.

17. Be sure to skip a line between each paragraph and, preferably, indent the first line of each paragraph. [Note: Some writers will tell you not to indent the first line of each paragraph in professional correspondence; however, I feel that this makes the correspondence more difficult to read, so I encourage indenting or tabbing in on the first line of each paragraph.] This makes it easier on the reader and more likely that your ideas will not get lost in a crowd of words.

18. Keep your paragraphs short and to the point. Nothing turns readers off as much as a single lengthy paragraph written from margin to margin taking up the whole page. I suppose some people may have never been taught what paragraphs are. However, I am willing to bet that most were. These rare used even in foreign countries.

19. In longer correspondence, use section headings (in bold or underlined) or headings for each issue, to better organize it. Think of these as road signs on a long road. They help the reader to know where he or she is at any given time, and where he or she is going.

20. When using headers, skip two lines before the header and one line after the header. This helps to set off the new section and header and show a definite division.

21. Keep your language objective and professional. Do not ever use profanity [Oops, I just went back and removed the word “damn” I used above.] Do not ever use any comments even remotely resembling racism, sexism, or antisemitism or prejudice. Do not be sarcastic.

22. Be direct and concise in your language. To the greatest extent possible, use the same terminology and wording that the other party uses, or has used, or the wording used in whatever statutes, regulations, policies, procedures, instructions, or governing documents with which you are dealing (but also, be sure you know what the words and terms mean).

23. If you intend to request a formal hearing say “I request a formal hearing.” If you want a full refund, state: “I request a full refund.” If you want to appeal the decision, state: “I want to appeal the decision.” Don’t be wishy-washy or vague. For example, don’t say, “I am looking for an attorney to file an appeal for me,” when what you mean to say is “I appeal the decision” or “I request an appeal.” Say precisely what you want. Don’t be vague or leave the reader guessing.

24. If there are any deadlines by which you must respond, be aware of these and make sure your response is received by that date. Remember “received” means “actually received” by the correct person (or office) at the correct address. It does not mean “mailed by” or “postmarked by.” If you have correspondence or a document to which a response must be received by a ceratin date, you need to make sure it is actually in the receiving person’s hands by that date, even if you must hand carry it to that person. I will usually send important documents by two different methods, in case the mail man dies, the courier service’s plan crashes or the e-mail server goes down.

25. In closing your correspondence conclude by stating what action is next, whether this is action you intend to take, or action you are requesting the other party to take. For example: “I expect to hear from you within ten days as to whether you grant my request or not.” “Please contact me with hearing dates within the next fourteen days.” “I will forward you a refund within five days.” “I will send you my records within five days.”

26. Always advise the other party of exactly how they should contact you; provide multiple means of contacting you. If you are very busy or have an assistant who is authorized to act for you, provide that person’s name and contact information to use as an alternate, as well. Then be available to receive the return communication(s). Don’t give telephone numbers you never answer. Don’t provide an incorrect address (e-mail or physical).

27. In dealing with dates and deadlines, remember that ten days is ten days; fourteen days is fourteen days, twenty-one days is twenty-one days. Made up rules such as “weekends and holidays don’t count” are just that, made up (outside of formal court proceedings). If the other party has given you “fourteen days to respond,” this means fourteen days from the date on the letter, unless specifically stated otherwise. Fourteen days means fourteen days, unless it is specifically stated otherwise (e.g., “you have fourteen business days to reply”).

28. Include a professional closing above your signature. This should be “Sincerely,” “Sincerely yours,” “Respectfully,” “Respectfully submitted,” or some other professional closing. Do not conclude with “Love,” or “Very truly yours,” despite the tradition.

29. In your signature block, include your full typed name, with credentials and title or position listed. For example, your full name, followed by your degree and other credentials (e.g., “John J. Smith, M.D., F.A.A.C.P.”) should be on the line immediately below where you sign. Next should be listed your position within your organization (if applicable) (e.g., “Chair, Pediatrics Department”).

30. If you have enclosures, list them at the end of the correspondence, giving a brief or shortened description and numbering them (this is slightly different from military correspondence). List and number them in the order you discuss them in your correspondence. Be sure they are properly organized, labeled, and divided, especially if any are lengthy.

Following these simple rules, most people learn in middle school will help to keep your correspondence professional looking and in conformity with what most professionals see on a daily basis. If your correspondence is professional-looking, people will be more likely to think you are a professional and to treat you professionally.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

Florida Attorney Says AHCA Must Put Medicaid Final Orders Online

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

Florida’s Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against AHCA, trying to force AHCA into compliance with state public records laws.

Attorney Nancy Wright says the AHCA orders fall under a state law that requires all proceedings determined by a state agency to be placed into a centralized electronic database accessible to the public. This would allow citizens and healthcare providers more accessible access to those decisions and transparency when understanding Medicaid policies and decisions made by AHCA.

Access to Medicaid Final Orders.

The plaintiff’s attorney argued before a three-judge panel of the court of appeal that she should not be required to pay hundreds of dollars to gain access to Medicaid final orders to prepare for clients’ Medicaid hearings when the law requires the agency to publish these. The attorney further argued that this fee was an unfair and unjustified barrier to justice and that she should be given free access to these orders to ensure that she could provide the best possible representation for her clients.

More Details of the Case.

The Florida Health Justice Project and the National Health Law Program filed the lawsuit against AHCA on behalf of Wright in December 2020 in the First District Court of Appeal of Florida.
“[Medicaid law’s] notorious complexity and rapid regulatory changes put even lawyers on edge,” she said in a statement at the time she filed her suit. “AHCA’s unwillingness to make their [sic] final orders accessible means that I am not able to fully advise my clients on how and why decisions on services are being made. For the many enrollees who are unrepresented, this lack of transparency makes a complicated system almost impossible to navigate.”

Click here to view the press release from The Florida Health Justice Project.

However, the trial court sided with AHCA and granted summary judgment to the agency.

The Appeal.

The Elder Law Section of the Florida Bar expressed their support for Wright and submitted an amicus brief on appeal. They highlighted that the Florida Department of Children and Families regulates Medicaid eligibility proceedings with the same law that provides authority to AHCA. Furthermore, the Department publishes its final orders in an electronic database, making them readily available to the public.

However, accessing these same orders on Medicaid coverage requires a public records request which can be costly and time-consuming. The Elder Law Section argued in its brief that this disparity is unfair as it burdens those attempting to gain access to said records. The brief further suggested that upholding the trial court’s summary judgment would only perpetuate this inequality of access to public records.

To learn more, read the complaint in full here.

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

Physicians, therapists, counselors and other health professionals who accept Medicaid are routinely audited by the Medicaid Program to detect any overpayments or fraudulent claims. Medicaid fraud is a serious crime and is vigorously investigated by the state Medicaid Fraud Control Unit (MFCU), the Agency for Healthcare Administration (AHCA), Program Integrity Contractors (PICs), the FBI, and 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 may also 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 law 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, mental health counselors, therapists, 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 toll free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.

Florida Attorney Says AHCA Must Put Medicaid Final Orders Online

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

Florida’s Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against AHCA, trying to force AHCA into compliance with state public records laws.

Attorney Nancy Wright says the AHCA orders fall under a state law that requires all proceedings determined by a state agency to be placed into a centralized electronic database accessible to the public. This would allow citizens and healthcare providers more accessible access to those decisions and transparency when understanding Medicaid policies and decisions made by AHCA.

Access to Medicaid Final Orders.

The plaintiff’s attorney argued before a three-judge panel of the court of appeal that she should not be required to pay hundreds of dollars to gain access to Medicaid final orders to prepare for clients’ Medicaid hearings when the law requires the agency to publish these. The attorney further argued that this fee was an unfair and unjustified barrier to justice and that she should be given free access to these orders to ensure that she could provide the best possible representation for her clients.

More Details of the Case.

The Florida Health Justice Project and the National Health Law Program filed the lawsuit against AHCA on behalf of Wright in December 2020 in the First District Court of Appeal of Florida.
“[Medicaid law’s] notorious complexity and rapid regulatory changes put even lawyers on edge,” she said in a statement at the time she filed her suit. “AHCA’s unwillingness to make their [sic] final orders accessible means that I am not able to fully advise my clients on how and why decisions on services are being made. For the many enrollees who are unrepresented, this lack of transparency makes a complicated system almost impossible to navigate.”

Click here to view the press release from The Florida Health Justice Project.

However, the trial court sided with AHCA and granted summary judgment to the agency.

The Appeal.

The Elder Law Section of the Florida Bar expressed their support for Wright and submitted an amicus brief on appeal. They highlighted that the Florida Department of Children and Families regulates Medicaid eligibility proceedings with the same law that provides authority to AHCA. Furthermore, the Department publishes its final orders in an electronic database, making them readily available to the public.

However, accessing these same orders on Medicaid coverage requires a public records request which can be costly and time-consuming. The Elder Law Section argued in its brief that this disparity is unfair as it burdens those attempting to gain access to said records. The brief further suggested that upholding the trial court’s summary judgment would only perpetuate this inequality of access to public records.

To learn more, read the complaint in full here.

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

Physicians, therapists, counselors and other health professionals who accept Medicaid are routinely audited by the Medicaid Program to detect any overpayments or fraudulent claims. Medicaid fraud is a serious crime and is vigorously investigated by the state Medicaid Fraud Control Unit (MFCU), the Agency for Healthcare Administration (AHCA), Program Integrity Contractors (PICs), the FBI, and 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 may also 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 law 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, mental health counselors, therapists, 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 toll free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.

Florida Attorney Says AHCA Must Put Medicaid Final Orders Online

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

Florida’s Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against AHCA, trying to force AHCA into compliance with state public records laws.

Attorney Nancy Wright says the AHCA orders fall under a state law that requires all proceedings determined by a state agency to be placed into a centralized electronic database accessible to the public. This would allow citizens and healthcare providers more accessible access to those decisions and transparency when understanding Medicaid policies and decisions made by AHCA.

Access to Medicaid Final Orders.

The plaintiff’s attorney argued before a three-judge panel of the court of appeal that she should not be required to pay hundreds of dollars to gain access to Medicaid final orders to prepare for clients’ Medicaid hearings when the law requires the agency to publish these. The attorney further argued that this fee was an unfair and unjustified barrier to justice and that she should be given free access to these orders to ensure that she could provide the best possible representation for her clients.

More Details of the Case.

The Florida Health Justice Project and the National Health Law Program filed the lawsuit against AHCA on behalf of Wright in December 2020 in the First District Court of Appeal of Florida.
“[Medicaid law’s] notorious complexity and rapid regulatory changes put even lawyers on edge,” she said in a statement at the time she filed her suit. “AHCA’s unwillingness to make their [sic] final orders accessible means that I am not able to fully advise my clients on how and why decisions on services are being made. For the many enrollees who are unrepresented, this lack of transparency makes a complicated system almost impossible to navigate.”

Click here to view the press release from The Florida Health Justice Project.

However, the trial court sided with AHCA and granted summary judgment to the agency.

The Appeal.

The Elder Law Section of the Florida Bar expressed their support for Wright and submitted an amicus brief on appeal. They highlighted that the Florida Department of Children and Families regulates Medicaid eligibility proceedings with the same law that provides authority to AHCA. Furthermore, the Department publishes its final orders in an electronic database, making them readily available to the public.

However, accessing these same orders on Medicaid coverage requires a public records request which can be costly and time-consuming. The Elder Law Section argued in its brief that this disparity is unfair as it burdens those attempting to gain access to said records. The brief further suggested that upholding the trial court’s summary judgment would only perpetuate this inequality of access to public records.

To learn more, read the complaint in full here.

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

Physicians, therapists, counselors and other health professionals who accept Medicaid are routinely audited by the Medicaid Program to detect any overpayments or fraudulent claims. Medicaid fraud is a serious crime and is vigorously investigated by the state Medicaid Fraud Control Unit (MFCU), the Agency for Healthcare Administration (AHCA), Program Integrity Contractors (PICs), the FBI, and 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 may also 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 law 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, mental health counselors, therapists, 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 toll free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.

Florida Attorney Says AHCA Must Put Medicaid Final Orders Online

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

Florida’s Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against AHCA, trying to force AHCA into compliance with state public records laws.

Attorney Nancy Wright says the AHCA orders fall under a state law that requires all proceedings determined by a state agency to be placed into a centralized electronic database accessible to the public. This would allow citizens and healthcare providers more accessible access to those decisions and transparency when understanding Medicaid policies and decisions made by AHCA.

Access to Medicaid Final Orders.

The plaintiff’s attorney argued before a three-judge panel of the court of appeal that she should not be required to pay hundreds of dollars to gain access to Medicaid final orders to prepare for clients’ Medicaid hearings when the law requires the agency to publish these. The attorney further argued that this fee was an unfair and unjustified barrier to justice and that she should be given free access to these orders to ensure that she could provide the best possible representation for her clients.

More Details of the Case.

The Florida Health Justice Project and the National Health Law Program filed the lawsuit against AHCA on behalf of Wright in December 2020 in the First District Court of Appeal of Florida.
“[Medicaid law’s] notorious complexity and rapid regulatory changes put even lawyers on edge,” she said in a statement at the time she filed her suit. “AHCA’s unwillingness to make their [sic] final orders accessible means that I am not able to fully advise my clients on how and why decisions on services are being made. For the many enrollees who are unrepresented, this lack of transparency makes a complicated system almost impossible to navigate.”

Click here to view the press release from The Florida Health Justice Project.

However, the trial court sided with AHCA and granted summary judgment to the agency.

The Appeal.

The Elder Law Section of the Florida Bar expressed their support for Wright and submitted an amicus brief on appeal. They highlighted that the Florida Department of Children and Families regulates Medicaid eligibility proceedings with the same law that provides authority to AHCA. Furthermore, the Department publishes its final orders in an electronic database, making them readily available to the public.

However, accessing these same orders on Medicaid coverage requires a public records request which can be costly and time-consuming. The Elder Law Section argued in its brief that this disparity is unfair as it burdens those attempting to gain access to said records. The brief further suggested that upholding the trial court’s summary judgment would only perpetuate this inequality of access to public records.

To learn more, read the complaint in full here.

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

Physicians, therapists, counselors and other health professionals who accept Medicaid are routinely audited by the Medicaid Program to detect any overpayments or fraudulent claims. Medicaid fraud is a serious crime and is vigorously investigated by the state Medicaid Fraud Control Unit (MFCU), the Agency for Healthcare Administration (AHCA), Program Integrity Contractors (PICs), the FBI, and 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 may also 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 law 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, mental health counselors, therapists, 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 toll free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.

Florida Attorney Says AHCA Must Put Medicaid Final Orders Online

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

Florida’s Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against AHCA, trying to force AHCA into compliance with state public records laws.

Attorney Nancy Wright says the AHCA orders fall under a state law that requires all proceedings determined by a state agency to be placed into a centralized electronic database accessible to the public. This would allow citizens and healthcare providers more accessible access to those decisions and transparency when understanding Medicaid policies and decisions made by AHCA.

Access to Medicaid Final Orders.

The plaintiff’s attorney argued before a three-judge panel of the court of appeal that she should not be required to pay hundreds of dollars to gain access to Medicaid final orders to prepare for clients’ Medicaid hearings when the law requires the agency to publish these. The attorney further argued that this fee was an unfair and unjustified barrier to justice. She should be given free access to these orders to provide her clients the best possible representation.

More Details of the Case.

The Florida Health Justice Project and the National Health Law Program filed the lawsuit against AHCA on behalf of Wright in December 2020 in the First District Court of Appeal of Florida.
“[Medicaid law’s] notorious complexity and rapid regulatory changes put even lawyers on edge,” she said in a statement when she filed her suit. “AHCA’s unwillingness to make their [sic] final orders accessible means that I cannot fully advise my clients on how and why decisions on services are being made. This lack of transparency makes a complicated system almost impossible to navigate for the many unrepresented enrollees.”

View the press release from The Florida Health Justice Project.

However, the trial court sided with AHCA and granted summary judgment to the agency.

The Appeal.

The Elder Law Section of the Florida Bar expressed their support for Wright and submitted an amicus brief on appeal. They highlighted that the Florida Department of Children and Families regulates Medicaid eligibility proceedings with the same law that provides authority to AHCA. Furthermore, the Department publishes its final orders in an electronic database, making them readily available to the public.

However, accessing these same orders on Medicaid coverage requires a public records request which can be costly and time-consuming. In its brief, the Elder Law Section argued that this disparity is unfair as it burdens those attempting to access said records. The brief further suggested that upholding the trial court’s summary judgment would only perpetuate this inequality of access to public records.

To learn more, read the complaint in full here.

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

Physicians, therapists, counselors, and other health professionals who accept Medicaid are routinely audited by the Medicaid Program to detect overpayments or fraudulent claims. Medicaid fraud is a severe crime and is vigorously investigated by the state Medicaid Fraud Control Unit (MFCU), the Agency for Healthcare Administration (AHCA), Program Integrity Contractors (PICs), the FBI, and the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Other state and federal agencies may also participate, including the U.S. Postal Service (USPS) and other law enforcement agencies. 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 law 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, mental health counselors, therapists, home healthcare 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 toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.

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