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The Escalating Consequences of Forgetting to Update a Physician Profile

by Matthew T. Wright on Categories: health law

The Escalating  Consequences of Forgetting to  Update a Physician Profile
By Matthew T. Wright


Imagine, for a moment, that your client is a practicing physician in Florida who has just accepted a lucrative opportunity to move her medical practice to another Florida location. Excited about the next chapter of her career and overwhelmed by the hassles associated with her move, she forgets to contact the Department of Health (DOH) and AHCA to update her physician profile information. After a few months pass, she has settled into her new job and home, and then a package arrives from the DOH along with letters from the AHCA that appear to have been forwarded to her from her prior address. As she reads the DOH letter, she realizes, for the first time, that she has forgotten to provide updated address information to AHCA and, as a result, AHCA has terminated her Medicaid privileges. Moreover, the DOH letter informs her that, because she has failed to report AHCA’s termination of her Medicaid privileges to the DOH, the DOH has now terminated her physician’s license. Unable to practice medicine and facing what could become months of appeals and substantial fines and legal fees necessary to resolve the pending disciplinary matters against her, the gravity of your client’s seemingly minor oversight becomes clear.

Unfortunately, this scenario has become a reality for some physicians in Florida. This article outlines the procedures that should be implemented in your client’s physician practice today to ensure strict compliance with DOH and AHCA physician profile requirements.

Duty to Provide Updated Address Applies to Both the DOH and AHCA

First, it is essential for your client to understand that a physician has a dual obligation to provide an updated address profile to both the DOH and AHCA. Specifically in regards to the DOH, Florida law requires that physicians provide written notice of any and all changes to their address within 15 days after the address change occurs. Additionally, a physician’s failure to provide such information provides the DOH with authority to pursue a variety of disciplinary options such as fines of up to $100 a day, termination of a physician’s professional license, and/or obligations to pay for the costs and fees associated with a physician’s own investigation.

Pursuant to Florida Medicaid law, AHCA has also implemented a thorough screening and ongoing review process for all physicians participating in the Florida Medicaid program. As a result, a physician’s failure to provide up-to-date address information will likely be discovered by AHCA during one of their frequent unannounced site visits or as a result of AHCA correspondence sent to the physician’s last known address, which is subsequently returned to the agency. If AHCA makes such a discovery, it can then move forward with a suspension of the physician’s Medicaid payment privileges, which can then turn into a denial of payment if no response from the physician has been received after 90 days. Furthermore, if the physician’s failure to respond to the charges and communications from AHCA continues, AHCA may pursue other sanctions such as fines, recoupment actions, and even the termination of a physician from the Medicaid program.

Additionally, the DOH can pursue disciplinary actions against a physician based on its discovery of sanctions levied by the AHCA against a physician. For example, physicians who have updated their address information with the DOH but have forgotten to update their address with AHCA after moving to a new practice location may have their Medicaid payment privileges suspended or terminated. However, because the correspondence from AHCA will likely have been sent to the physician’s former address, the physician may be practicing medicine, entirely unaware of the fact that their Medicaid privileges have been terminated. If so, the DOH may be the entity that initially provides the offending physician with notice that their Medicaid privileges have been terminated by AHCA. This notice may also confirm that, because of the revocation of the physician’s Medicaid privileges, the DOH has terminated the physician’s professional license.

In light of these severe and escalating penalties, physicians must make sure that strict compliance with DOH and ACHA profile reporting requirements becomes a priority in the operation of their medical practice. At a minimum, procedures should be established that ensure, and continue to periodically confirm, continued compliance with the profile reporting requirements of both the DOH and AHCA.

Matthew T. Wright is an income partner at Zumpano Patricios & Winker, P.A. He focuses his practice on litigation and regulatory matters. He can be reached at 312 Minorca Ave., Coral Gables, FL 33134 305-444-5565 mwright@zpwlaw.com www.zpwlaw.com


South Florida Legal Guide Midyear 2014 Edition

Tags: healthcare physician

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