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Asserting your rights and living to fight another day 850-591-4875 1 James M. Barclay Healthcare attorney.

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Presentation on theme: "Asserting your rights and living to fight another day 850-591-4875 1 James M. Barclay Healthcare attorney."— Presentation transcript:

1 Asserting your rights and living to fight another day James M. Barclay Healthcare attorney

2 Factors in deciding what to do next Action deadlines Provider options Using outside influence Steps in a formal administrative hearing Session take-aways

3 Regulation will continue State agency will return State has unlimited manpower and financial resources Financial and licensure renewal threats of present matter Cost-benefit of mounting a defense Establishing/maintaining provider credibility Withholding of Medicaid payments Most cases settle Termination from Medicaid

4 Involve competent counsel at outset Agency action in writing Notice of Intent to Deny Final Audit Letter Information about administrative hearing rights Usually 21 days from receipt Election of Rights Form

5 Do nothing Informal administrative hearing Formal administrative hearing Rule challenge/challenge to agency statement

6 Agency will enter Final Order by default for relief requested Minimal fees Matter kept below radar

7 Usually favors the Agency Agency facts Agency law Agency prosecutor Agency hearing officer

8 Petition for formal administrative hearing Disputed issues of material facts Filed with Agency but heard by Administrative Law Judge Significantly levels the Medicaid/Provider playing field

9 Filed with and decided by Administrative Law Judge Expedited discovery Hearing in 30 days Increased attention to issues Escalates stakes and puts issue/Provider on radar

10 Final Order issued by Administrative Law Judge Significant restrictions can accompany Final Order Right to judicial review

11 Exercise carefully Swarm of gnats Nuclear strike

12 Assignment of Case Number and ALJ Initial Order Pre-hearing instructions Hearing within 30 but not more than 90 days

13 Depositions Requests for admission Requests to produce Motion practice to enforce compliance with procedural rules

14 Live and video capability Opening statements Testimony under oath Documents in support of positions Closing statements Electronically transcribed

15 Trial transcript Submit proposed recommended orders annotated to trial transcript ALJ submits recommended order to Agency

16 Deadline Filed with Agency Agency usually bound by findings of fact Agency has latitude with conclusions of law

17 Issued by Agency Head Written disposition of issues Addresses exceptions to recommended order May adopt or articulate findings of fact and conclusions of law Filed with Agency Clerk Notice of appellate rights

18 District Court of Appeal Agency headquarters Provider’s location 30 days from rendition of Final Order to appeal

19 Involve competent counsel at the outset Determine deadlines Confirm receipt of Agency Notice Select course of action and take timely action Formal administrative hearing keeps options open and levels playing field Companion rule challenge/challenge to agency statement can increase stakes

20 Thank you for your attention


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