Medicaid and Medicare Qui Tam or Whistleblower Cases and False Claims Act

In addition to our other experience in Medicare and Medicaid cases, given below, we also represent health care professionals in qui tam or whistleblowers cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, and other experts that assist us in such matters.

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.

It is extremely important that the health care provider obtain experienced professional representation in responding to a Medicaid Program audit notice. There are many problematic legal issues that a Medicaid audit seeks to identify in such audits. Correct responses to audit questionnaires and the provision of complete, legible, well-organized, responsive medical records (and other supporting documentation) must be provided. This is crucial from the very beginning.

The receipt of the Provisional Agency Audit Report (PAAR) is another opportunity to provide documents, explanations, medical authority, legal authority and other documentation that may reduce or eliminate any repayment to the Medicaid Program.

After receipt of a demand for an overpayment that may be alleged to be due to the Medicaid Program (in Florida, administered by the Florida Agency for Health Care Administration or “AHCA,” and its contractors), it may still be possible to negotiate a repayment or settlement of the matter on favorable terms.

If not, then The Health Law Firm and its attorneys are experienced in representing the health care provider in formal administrative hearings, in civil litigation or in appeals, on such matters.

Our attorneys are experienced in handling appeals of denials of Medicaid Cost Reimbursement Reports for health care providers.

In the event that a health care professional receives a subpoena or search warrant for records concerning a Medicaid criminal investigation, our attorneys are experienced in dealing with investigators and state’s attorneys, including attorneys and investigators working for the Attorney General’s Medicaid Fraud Control Unit, in defending the health care provider and attempting to resolve the case before criminal charges are filed.

We assist providers in obtaining Medicare and Medicaid provider status (provider identification numbers), as well as, in proceedings seeking to revoke or terminate a health care provider’s Medicare and Medicaid provider status. We also advise clients on performing internal audits of Medicare and Medicaid services, billing, reimbursement and on how to make voluntary refunds of overpayments to the Medicare and Medicaid Progams.