What You Need to Know About Preparing and Responding to an Initial Medicaid Audit Request

1 Indest-2008-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Health care providers in Florida who service Medicaid patients are at a higher risk for audits than anywhere else in the country. The unfortunate truth is that Florida has become synonymous with health care fraud. As a result, auditing and subsequent overpayment demands are very real possibilities.

The Health Law Firm and its legal professionals represent health care providers in virtually every aspect of Medicaid program audits, investigations and litigation. These include physicians, medical groups, mental health professionals, pharmacies, nursing homes, home health agencies, hospitals and other health facilities.

Facts You Should Know About the Medicaid Audit Process.

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 to remember is that just because you are being audited, it does not mean that you or your business have done anything wrong. State and federal governments conduct audits for several different reasons. Typical ones include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing and complaints of possible fraud.

If You Are the Subject of an Audit.

A Medicaid audit will usually begin with the provider receiving an initial audit request, usually by letter or fax. This request will serve to notify the recipient that it is the subject of an audit. The initial letter will not always identify the reason for the audit. It will, however, contain a list of names and dates of service for which the auditors want to see copies of medical records and other documentation.

Once the records are compiled and sent to the auditor, the process shifts and you are now going to have to dispute the auditor’s findings in order to avoid overpayment.

The biggest mistake that someone who is the subject of an audit can make is to hastily copy only a portion of the available records and send them off for review. The temptation is to think that because the records make sense to you, they will make sense to the auditor. Remember, the auditor has never worked in your office and has no idea how the records are compiled and organized. This is why it is so important to compile a thorough set of records. The records should be presented in a clearly labeled and organized fashion that provide justification for every service or item billed.

Compiling a Response to an Initial Audit Request.

The following are steps that you should take in order to compile and provide a set of records that will best serve to help you avoid any liability at the conclusion of the audit process:

1. Read the audit letter carefully and provide everything that it asks for. It’s always better to send too much documentation than too little.

2. If at all possible, compile the records yourself. If you can’t do this, have a compliance officer, experienced consultant, or experienced health attorney compile the records and handle any follow-up requests.

3. Pay attention to the deadlines. If a deadline is approaching and the records are not going to be ready, contact the auditor and request an extension before it is due. Do this by telephone and follow up with a letter (not an email). Send the letter before the deadline.

4. Send a cover letter with the requested documents and records explaining what is included and how it is organized as well as who to contact if the auditors have any questions.

5. Number every page of the records sent from the first page to the last page of documents.

6. Make a copy of everything you send exactly as it is sent. This way there are no valid questions later on as to whether a particular document was forwarded to the auditors.

7. Send the response package using some form of package tracking or delivery confirmation to arrive before the deadline.

Compiling all of the necessary documentation in a useful manner can be an arduous task. If you find that you cannot do it on your own, or that there are serious deficiencies in record keeping, it is recommended that you reach out to an attorney with experience in Medicaid auditing to assist you in the process.

To learn how The Health Law Firm can assist you with a Medicaid audit, click here.

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

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing 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 http://www.TheHealthLawFirm.com.

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, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.
KeyWords: Medicaid fraud defense attorney, Medicaid audit defense attorney, legal representation for false billing, legal representation for Medicaid overpayment, legal representation for Medicaid audit, legal representation for Medicaid investigation, health care fraud defense attorney, Medicaid fraud attorney, Centers for Medicare & Medicaid Services (CMS) , legal representation for allegations of overbilling, audit defense attorney, ZPIC audit defense attorney, legal counsel for responding to Medicaid audits, legal representation for Medicaid fraud allegations, legal counsel for Medicaid audits, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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 © 2017 The Health Law Firm. All rights reserved.

Mother and Daughter-In-Law Arrested for Allegedly Defrauding Medicaid Out of More Than $70,000

6 Indest-2008-3By 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 20, 2014, the pair was arrested for allegedly running a scheme that involved billing the Medicaid program for services never rendered.

Click here to read the press release from the AG.

Mother and Daughter-In-Law Claimed to Provide Services to Developmentally Disabled Child.

According to the AG, the mother and daughter-in-law allegedly ran a scheme that involved billing the Medicaid program for services that were not actually provided to the mother’s developmentally disabled son. It’s alleged the mother submitted timesheets for work that was not provided. The press release did not state how the daughter-in-law was specifically involved in the scheme.

The mother and daughter-in-law are each charged with one count of Medicaid fraud, which is a first-degree felony. If convicted, the pair could face up to 30 years in prison and up to $10,000 in fines and restitution. Additionally, if convicted, this would be a crime of health care fraud. The collateral consequences could be devastating.

According to the AG, the Florida Medicaid Fraud Control Unit (MFCU) and the Tampa Police Department arrested the mother of the child, and the Chesterfield County Sheriff’s Department in South Carolina arrested the daughter-in-law.

When the MFCU is Involved, the Investigation is Serious.

The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.

Medicare and Medicaid Audits Should Not Be Dismissed.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

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 Health Care 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 speech therapists, occupational therapists, vocational therapists, therapy groups, 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.

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Source:

Jenn, Meale. “Attorney General Pam Bondi’s Office Announces the Arrest of Mother and Daughter-in-Law Duo for More Than $70,000 of Medicaid Fraud.” My Florida Legal. (February 20, 2014). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/5A11AC9DE5E6269A85257C85006D7EE3


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 © 1996-2014 The Health Law Firm. All rights reserved.

Two Owners of Florida Counseling Center Arrested for Allegedly Defrauding Medicaid Out of $80,000

10 Indest-2008-7By 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 (AG), the pair was arrested on December 11, 2013. The owners were arrested after an investigation by the AG’s Medicaid Fraud Control Unit (MFCU) revealed that they allegedly bilked the Medicaid program out of $80,000.

Click here to read the press release from the AG.

Pair Charged With Participating in an Organized Scheme to Defraud Medicaid.

According to a Daily Commercial article, the two owners ran a counseling center that was suppose to link Medicaid recipients with a mental health condition to state-approved mental health counseling centers in the community. However, the MFCU’s investigation uncovered that the owners allegedly billed Medicaid for services that were never rendered. According to the investigation, the duo also instructed their employees to bill for entire families when only one family member received services. Employees of the ministry also allegedly billed for unauthorized expenses. Additionally, it is alleged the ministry received reimbursements for services provided to children who did not have any documented mental health condition.

The two owners are both charged with one count of participating in an organized scheme to defraud Medicaid, according to the Daily Commercial. If convicted, they each face up to 15 years in prison, up to $10,000 in fines, and restitution. Click here to read the article from the Daily Commercial.

Responding to a MFCU Investigative Subpoena.

The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.

Take Fraud Charges Seriously.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

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 Health Care 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 www.TheHealthLawFirm.com.

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Sources:

Ray, Whitney. “Attorney General Bondi’s Office Announces Arrest of Lake County Couple for Nearly $80,000 Medicaid Fraud.” Florida Attorney General. (December 11, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/7BAB936C94315B3885257C3E006F8895

Daily Commercial. “Ministry Owners Charged with Medicaid Fraud.” Daily Commercial. (December 12, 2013). From: http://www.dailycommercial.com/news/article_cc247b13-5771-5da4-9cab-545c5614aa91.html

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 © 1996-2012 The Health Law Firm. All rights reserved.

Director of Center for Developmentally Challenged Adults Accused of Medicaid Fraud

The director of a center for developmentally challenged adults in Okaloosa County, Florida, was arrested on August 16, 2012, for allegedly fraudulently billing Medicaid for more than $270,000 for services under the Medicaid Developmentally Disabled Waiver Program, according to the Attorney General’s (AG) office.

To read the entire press release from the AG’s office, click here.

Director Allegedly Submitted False Claims for Non-Billable Services and Falsified Hours.

According to the press release, in 2009, the Medicaid Fraud Control Unit (MFCU) began investigating the center after it received a referral from the Agency for Persons with Disabilities (APD). The director allegedly submitted claims seeking $270,000 in reimbursements for non-billable services and falsified hours to the Medicaid program.

Director Faces Serious Medicaid Fraud Charges.

The director of the center has been charged with one count of first-degree Medicaid fraud and two counts of third-degree Medicaid fraud. If convicted, the director could receive 40 years in prison and $25,000 in fines, this is all according to the AG’s Office.

To learn more on our experience with Medicaid investigations, click here.

MFCU and State and Federal Auditing Agencies.

The MFCU receives referrals from many other state and federal agencies. Often, matters that could be resolved as simple billing errors get escalated to criminal charges when Medicaid providers are interviewed and give evidence against themselves. Admitting to any misconduct, no matter how slight, may lead to far more serious criminal charges.

Click here for tips on how to respond to a Medicaid audit.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.

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, 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.

Sources:

McFarland, Molly. “Attorney General’s Office Arrests Okaloosa County Resident for $270,000 in Medicaid Fraud.” Florida Office of the Attorney General. (August 16, 2012). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/B2185C605D2C5BF985257A5C0065645A

Ricketts, Dusty. “Local Nonprofit Director Charged with Medicaid Fraud.”NWFdailynews.com. (August 16, 2012). From: http://www.nwfdailynews.com/articles/fraud-51752-medicaid-.html

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 © 1996-2012 The Health Law Firm. All rights reserved.