In Florida, any complaint could lead to facing two distinct issues simultaneously for healthcare professionals. First, the AHCA may launch an administrative investigation into your licence. Second, there may be a separate investigation conducted behind closed doors under provisions of the False Claims Act, the Anti-Kickback Statute, or other federal laws. These proceedings follow different procedures and have separate evidentiary standards and consequences. However, a mistake in one process could seriously undermine your position in the other, which is why seeking guidance from an experienced health care fraud attorney as early as possible can be critical to protecting your rights and defence strategy.
When State and Federal Cases Overlap
Sanctions imposed on AHCA licensees and federal investigations into healthcare fraud in the United States share many similarities and typically arise from a common set of circumstances, including billing issues, insufficient documentation, and complaints from former employees. The process of the AHCA involves the question of whether the licensee violated the state law, while the DOJ and HHS-OIG investigate whether the claims for Medicare and/or Medicaid were fraudulent. Since both entities are entitled to receive the same documents and conduct interviews with the same employees, what is said in one hearing can be used in another.
Why Licensing Actions Deserve Serious Attention
It is easy to think of an AHCA complaint as a bureaucratic hassle considering possible federal criminal charges; however, it is an error. Regardless of the outcome of the federal case, a suspended or revoked license marks the end of the provider's ability to practice and bill programs. In addition, AHCA actions occur on tight timelines, and providers responding without representation inadvertently give up rights or provide information that will be used in a federal case file.
The Role of a Health Care Fraud Attorney in Overlap Cases
An attorney representing health care fraud charges that involve both AHCA and federal government agencies needs to simultaneously strategize between the two systems. Such a situation involves controlling the information disclosed to AHCA, how the information disclosed may be used by the federal government, and whether the information disclosed fits the scope of a defense or safe harbor. The attorney needs to evaluate whether cooperating with one agency provides an advantage or disadvantage to another agency. The difference between an attorney who is competent in litigation and one who is competent in compliance issues is what defines their respective areas of expertise.
Building a Defense That Protects Both Your License and Your Freedom
A sound defense strategy for dealing with issues of overlap should begin with an audit of the facts, including the nature of any available documentation, its content, and any discrepancies that may prove problematic. Then, it will be possible to develop an integrated approach that does not compromise any critical point on the federal side while dealing effectively with the issues raised by AHCA administratively.
Frequently Asked Questions
Can AHCA and federal agencies investigate me for the same conduct?
Yes. AHCA polices state licensing laws, while the federal agencies police statutory violations associated with Medicare and Medicaid billing. The same set of facts can be used to bring either a licensing enforcement action or a federal investigation.
Does resolving an AHCA complaint end federal exposure?
No. Resolving an AHCA dispute does not compel federal agencies, which have different criteria and may independently investigate, irrespective of the licensing result.
Should I respond to AHCA before speaking with an attorney?
No. Anything said to AHCA may come up during a federal investigation, and healthcare providers would be wise to consult with an attorney prior to responding to AHCA.
What makes overlap cases different from standard compliance matters?
Navigating two legal frameworks with two sets of agencies and ramifications calls for a strategic approach taking into account both simultaneously.
Protecting What You Have Built
Being subject to inquiries from AHCA and federal agencies is overwhelming, but providers do not have to face it alone. Rosenberg Law, P.A. defends Florida healthcare providers with respect to their licenses as well as the other issues that arise when defending themselves in these types of disputes. Speaking with an attorney first may make the difference.
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