Health care providers face more scrutiny than ever before. Government investigations contain numerous pitfalls for the unwary. Learn how we can help through our guide, “Provider Beware – The Collateral Consequences of a Guilty Plea.” An excerpt follows:
Don't Forfeit Your Medicaid Provider Agreement
Even if you avoid exclusion and civil monetary penalties, Medicare and Medicaid regulations are full of traps for the unwary. Your guilty plea could lead to the loss of your Medicaid provider agreement. State Medicaid programs must terminate the Medicaid provider agreement of a provider who is convicted of any criminal activity materially related to the Medicare or Medicaid program. Thus, if there is some common sense nexus between the conviction and the Medicaid or Medicare program, your Medicaid provider agreement could be terminated. Medicaid programs also have the discretion to terminate the provider agreement of any provider who prescribes services that are not medically necessary.
The termination of your Medicaid provider agreement could lead to the revocation of your Medicare billing privileges. Medicare can revoke the billing privileges of a provider whose Medicaid provider agreement has been terminated. Upon doing so, Medicare will impose a re-enrollment ban of at least one year. A health care provider is also required to report “adverse legal actions” to Medicare within thirty days. In our hypothetical, this would include both the guilty plea and the subsequent termination of the Medicaid provider agreement. The failure to report these adverse actions is also grounds for revoking Medicare billing privileges.