Category Archives: Medicaid

15 Sep

Appeal of UPIC Audit Overpayment Determinations – A Multi-Step Approach

Mr. Gaitan is available to discuss his strategies and legal costs, including hourly and contingency fee arrangements with provider’s who have received a records request or have received an overpayment determination and demand letter from their MAC or would like to more about the process. Initial consultation fee is waived. Feel free to contact Rafael (Ralph) Gaitan, Esq. at (786) 440-8115 or via email at rg@ragaitanlaw.com

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29 Jan

Responding to the Omissions Notice.

The changes in Florida’s Medicaid enrollment and participation rules and regulations require that many previously unlicensed behavior analysis entities seek either licensure as health care clinic or seek exemption from licensure. See our previous post for additional facts regarding same here. As a result, many behavior analysis providers will need to file for licensure with

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10 Jan

Reminder – Deadline for Licensure required of Behavior Analysis Providers

Starting the New Year in 2020 means that Behavior Analysis providers in Florida will need to have a health care clinic license or exemption from licensure in order to avoid possible Medicaid payment interruptions. The deadline for compliance is July 1, 2020, however, the time to submit an application is now. For additional information regarding

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11 Feb

Home Health Agencies no longer under CMS moratorium

As of January 30, 2019, there are no active Medicare Provider Enrollment Moratoria in any State, including Florida, or U.S. territories. On July 31, 2013, the the Centers for Medicare and Medicaid Services (CMS) first issued a temporary moratorium which affected providers who desired to or where in the process of enrolling as a home

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11 Feb

How to respond to a Final Audit Report (FAR)

Florida health care providers that provide services to Medicaid recipients are likely, at some point, to receive an audit of their claims submitted to the Medicaid program for reimbursement. Some providers will, for any number of reasons, receive a preliminary audit report detailing the Agency for Health Care Administration’s (Agency) findings as well as setting

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07 Feb

Responding to Record Requests on a Timely Basis.

Health care providers are increasingly seeing request for records from all types of payors including but not limited Medicaid, Medicare and commercial insurance providers. The basis for receiving a requests for records could be as a result on any number of reasons, including compliance, aberrant billing practices or as a result of a ZPIC audit

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07 Feb

Florida Behavior Analysis Services – Overpayments

The Florida Agency for Health Care Administration (Agency), Medicaid Program Integrity (MPI) has and is undergoing review of several Behavior Analysis Services providers regarding their Medicaid reimbursement claims for services rendered. MPI is reviewing said claims in order to insure compliance with the program’s Florida Medicaid Behavior Analysis Services Coverage Policy dated October 2017, including

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