Facilities’ Medicaid Reimbursement: Hope After an AHCA Audit

Part one of a two-part series

This is how it typically happens. Your facility has been timely filing Medicaid cost reports with AHCA.  Yet, suddenly, you receive a notice from the Agency for Health Care Administration (AHCA) with an attached audit or Medicaid examination report that states you must refund AHCA a great deal of money due to the audit or examination. 

AHCA will cite s.409.913, Florida Statutes and may use such language as overpayment and “within acceptable and valid auditing, accounting, analytical, statistical or peer methods” in disallowing much of what was claimed for reimbursement. 

There is hope and a way to work with AHCA on this situation.  

I Received an AHCA Medicaid Examination Report and Notice. Now What?

Once a notice is received, your facility should prepare for the next steps. 

1. Keeping Your Address Current. Since AHCA will rely on this address as sufficient notice even if you have moved, it is your duty to keep your address updated so that the notice isn’t delivered to the wrong address.  
2. Keeping Your Records Handy. You may have (or most likely) received the notice for a time period that occurred years ago. Under the applicable rules and statutes, you must keep records for at least five years after furnishing the goods or services. In order to reply to AHCA, you need the records as proof of your position on any contested amounts concerning these services and goods. 
3. Act Fast. Upon receipt of the Notice with the Medicaid examination report or audit, note that you only have 21 days to file your appeal or request for hearing (RFH). This appeal or RFH must either request a formal hearing or an informal hearing. If your appeal or RFH does not meet the required legal standards, it will be rejected. Your appeal or RFH must contest certain specific facts and law to obtain a formal hearing.  You have one more chance to fix it or AHCA will default your case.  An attorney trained in this area will be able to complete the appeal or RFH.    

Legal Counsel’s Role in Your AHCA Medicaid Examination Report Appeal

After filing your appeal or RFH, legal counsel can help you navigate the process of resolving the issues raised by AHCA.  An experienced administrative law attorney can assist you in preparing the appeal or RFH and with identifying how to contest the issues correctly.  Contact Howell, Buchan & Strong if you need assistance for:

• Review of the AHCA Notice and attached Examination Report or audit;
• Advice and counsel on how to contest the disallowance of funds for the services and goods provided that are referenced in the audit or Examination Report;
• Discuss the ways AHCA handles the Examination Reports and how to extend the time period for contesting what was disallowed;
• Represent you against AHCA in legal proceedings. 

Read more about health care facility regulations.

Have Questions? Let’s Talk

Have questions about your need for legal representation? Contact the law firm of Howell, Buchan & Strong at 850-877-7776 to set up a FREE, no-obligation consultation. Our firm represents physicians, nurses, psychologists, and other licensed professionals statewide. 

Orlando (407) 717-1773 | Tallahassee (850) 877-7776 | Tampa (813) 833-6726 | Sarasota (941) 779-4348