In Florida, the Agency for Health Care Administration (AHCA) administers the Medicaid program. If you or your organization gets a letter that begins something like:
In accordance with Section 409.913, Florida Statutes (F.S.) and Rule 59G-9.070, Florida Administrative Code (F.A.C.), the Agency for Health Care Administration (Agency), shall apply sanctions for violations of federal and state laws, including the failure to maintain Medicaid-related records, and violations of Medicaid policy…..
just know that you are not alone. AHCA sends out thousands of similar letters to hospitals, nursing homes, assisted living facilities, and numerous other health care providers every year. The most common type of violations are failure to have records or documentation relating to: 1) treatment or resident service plans and/or 2) Certification of Medical Necessity.
You should also know that you have rights to challenge AHCA’s sanctions. These letters usually have a monetary sanction and some health care providers choose to simply pay the fine and move on. Others attempt to challenge the allegations or negotiate the fine downward. Ignoring these letters can result in cancellation of your Medicaid eligibility. You have rights which you need to be familiar with and plan strategically to address the allegations.
If you have encountered a problem with the Agency for Health Care Administration it is important to seek experienced legal advice before moving forward. More information can be found at www.floridahealthcareattorney.com or contact me directly at 850-222-7000. The initial consultation is free and there is no obligation.I represent licensed health care professionals and providers throughout Florida.