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Medicaid Tag

Jones Health Law > Posts tagged "Medicaid"

AHCA Application for Exemption from Disqualification

If you are reading this article it means that you have probably received a letter from the Agency for Healthcare Administration (“AHCA”) stating that they have uncovered criminal offenses that disqualify you from working for a health care provider. AHCA may have uncovered this offense a result of background screening submitted as part of the employment process for a health care provider and/or participation as a Medicaid provider. This applies to clinical staff as well as facility owners, administrators and chief financial officers and those seeking enrollment as a provider in the Florida Medicaid program. Fear not, because you may be eligible to file an Exemption from Disqualification if...

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Can I become a Federally Qualified Health Center?

Federally Qualified Health Centers (“FQHC”) are community-based healthcare providers that receive money for providing primary care services to under-served populations or areas. FQHCs were enacted under Section 1861(aa) of the Social Security Act and was amended by Section 4161 of the Omnibus Budget Reconciliation Act of 1990. FQHCs are required to adhere to certain criteria, including, but not limited to, providing comprehensive healthcare services (either on-site or by arrangement with another provider) on a sliding fee scale based on ability to pay and operating under a governing board that includes patients. These comprehensive services may include: (1) preventive health services; (2)...

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Reinstatement After A Healthcare Entity or Individual is Placed on the OIG and Florida’s Exclusion List

What is the Exclusion List? The Office of Inspector General’s (“OIG”) list of Excluded Individuals and Entities (“LEIE”) provides information to the healthcare industry, patients and the public regarding individuals and entities currently excluded from participation on in Medicare, Medicaid and all other Federal healthcare programs. OIG imposes exclusions under the authority of sections 1128 and 1156 of the Social Security Act. On May 8, 2013, the OIG released a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs, which states that no federal healthcare program payment may be made for items or services furnished by...

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Healthcare Provider Marketing and Management Arrangements

Healthcare providers interested in entering into marketing or management arrangements with companies must structure these arrangements in such a way that they don’t violate any federal or Florida healthcare laws. Providers should avoid entering into any marketing and management arrangements, which gives the impression that they offered, paid, or solicited cash, or any other type of remuneration in exchange for referring patients to that provider. Failure to do so may result in an Anti-Kickback violation if the arrangement does not fit squarely within an Ant-Kickback Statute Safe Harbor. Safe harbors that might be available to a healthcare provider, depending on the terms...

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Medicare Audit by Zone Program Integrity Contractor

If you’re reading this article it’s probably because you or your medical office has received a letter from a Zone Program Integrity Contractor (“ZPIC”) for The Centers for Medicare & Medicaid Services (“CMS”) alleging that you may have improperly billed Medicare for the provision Medicare Services to your patients.   What is a ZPIC? There are seven ZPIC zones. It is possible for providers to hear from more than one ZPIC since the seven ZPICs focus on different aspects of the Medicare program. ZPIC Zone 7 includes Florida, Puerto Rico, and the U.S. Virgin Islands in its geographic scope. The Zone 7 –...

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The Business of Healthcare: Post-Election

Jamaal R. Jones, Esq. attended a conference hosted by the University of Miami's Center for Health Sector Management and Policy on March 3, 2017. It was headlined by leaders from across the country. Panelists shared ideas on how the U.S. health care system will continue to evolve and how the anticipated changes will impact consumers, businesses and government over the next four years and beyond. Guest speakers participated in several discussions including: (A) A Conversation on the Election and Global Health Care Issues; (B) Election Impact on Health Care Sectors; (C) Health Care Policies Under the Trump Administration; (D) Election Impact on South Florida Health Care...

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Representing the Physician: It Is Harder Than it Looks

Jamaal R. Jones is a Super Lawyer committed to representing the physician. Mr. Jones recently attended a conference where Health Law attorneys from around Florida converged to discuss topics such as MACRA, HIPAA Audits, EMTALA, Medical Marijuana, Medicare and other Risk Contracts, and Structuring Medical Practices for Tax and Creditor Insulation. If you would like to discuss any of these topics in greater detail contact us today!...

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Keys to Successfully Operating a Multi-Disciplinary Medical Practice

Throughout Florida, a healthy number of licensed healthcare practitioners and healthcare entrepreneurs are joining or investing in multi-disciplinary practices for numerous reasons. The primary reason for their foray into this modern approach to the delivery of medicine is usually due to the rising costs of administering treatment. They are attracted to the idea of increasing revenue, minimizing administrative duties, and partnering with like-minded individuals that may grow their individual practice. However, there are several business and legal challenges that members of a multi-disciplinary practice must consider prior to participating in the practice....

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