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Notice Regarding Medicaid Provider On-site Activities

The purpose of this alert is to provide notice to Medicaid providers that employees from the Agency for Health Care Administration (AHCA) are authorized to have access to a Medicaid provider’s place of business and their Medicaid-related records, without prior notice. For more information about this authority, please see Section 409.907(3)(e), Florida Statutes, which requires providers to permit access to all Medicaid-related information. Employees from several organizational units within AHCA may present themselves at your offices, seeking the opportunity to conduct an on-site review. AHCA employees all carry an AHCA-issued identification badge that states their name, and the organizational office.

This alert is specific to the authority granted to AHCA, which is typically invoked by the Office of the Inspector General (OIG), Bureau of Medicaid Program Integrity (MPI), under s. 409.913, Florida Statutes. This statute reads, in pertinent part, as follows:

“409.913 Oversight of the integrity of the Medicaid program.—The agency shall operate a program to oversee the activities of Florida Medicaid recipients, and providers and their representatives, to ensure that fraudulent and abusive behavior and neglect of recipients occur to the minimum extent possible, and to recover overpayments and impose sanctions as appropriate…

(2) The agency shall conduct, or cause to be conducted by contract or otherwise, reviews, investigations, analyses, audits, or any combination thereof, to determine possible fraud, abuse, overpayment, or recipient neglect in the Medicaid program and shall report the findings of any overpayments in audit reports as appropriate.”

(15) The agency shall seek a remedy provided by law, including, but not limited to, any remedy provided in subsections (13) and (16) and s. 812.035, if:

(a) The provider’s license has not been renewed, or has been revoked, suspended, or terminated, for cause, by the licensing agency of any state;

(b) The provider has failed to make available or has refused access to Medicaid-related records to an auditor, investigator, or other authorized employee or agent of the agency, the Attorney General, a state attorney, or the Federal Government;

(c) The provider has not furnished or has failed to make available such Medicaid-related records as the agency has found necessary to determine whether Medicaid payments are or were due and the amounts thereof;

Medicaid providers may wish to read the entire section of statute to understand the full scope and purpose of MPI’s on-site visit. We appreciate your understanding of the minor inconvenience that our presence may cause. We take our responsibility to verify that you are in compliance with all federal and state Medicaid laws, rules and regulations very seriously. We are attempting to protect Florida’s citizens and to ensure that Medicaid dollars are spent as intended.

If MPI staff members come to your offices, we appreciate your cooperation. If you have any questions that are not addressed by the staff while they are on-site, they will be happy to follow up with you at a later time, and will freely provide you their supervisor’s name and contact information. Additional information about MPI, including contact information, is available on the MPI landing page on the AHCA website.

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Last Updated On: 12/4/2020