Provider Type(s): All

Reminder: Provider Obligations to Repay Money Due to AHCA

This notice is to remind Medicaid providers of their obligation to promptly refund moneys due to the Agency for Health Care Administration, including any moneys received in error or in excess of the amount to which the provider is entitled from the Medicaid program, or any moneys due as a result of the imposition of a fine or other fees or costs.  (See, Section 409.907(3)(g), Florida Statutes and paragraph 5(g) of the Non-institutional Medicaid provider agreement). 

Please remember that failure to pay moneys due to the Agency in full, or have a written repayment agreement in place with the Agency and comply with its terms, is grounds for termination from the Medicaid program, including participation in Medicaid managed care plan networks.  (See, Rule 59G-9.070 (2)(s), Florida Administrative Code, and Sections 409.913(25)(c) and 409.913(30), Florida Statutes).  Providers who have outstanding debts to the Agency may find that their future Medicaid reimbursements are withheld to offset the debt.  However, if the Agency is withholding reimbursements without a written repayment agreement, the provider is not in compliance with the obligation to repay moneys due and may still be terminated from participation in the Medicaid program. 

Providers with outstanding debts to the Agency are encouraged to remedy the obligation immediately to avoid upcoming collections and enforcement actions that will include termination of Medicaid participation. In the upcoming weeks the Agency will increase its efforts to ensure that providers are repaying overpayments.  Providers who have not reimbursed overpayments and who wish to avoid sanctions and/or investigative costs, should immediately submit a check to the Agency for the amount of any overpayments. To ensure proper credit, be certain you legibly record on your check your Medicaid provider number and the review I.D. numbers related to the overpayment findings.   Please ensure the checks are made payable to the Agency for Health Care Administration and are sent to:

Agency for Health Care Administration
Bureau of Financial Services, Revenue Management
2727 Mahan Drive, Mail Stop #14
Tallahassee, FL  32308

Providers are encouraged to conduct reviews of their claims to ensure they have billed the program in compliance with Medicaid policy.  Providers who perform self-audits may avoid being selected for audit, as well as avoid the costs of Agency-initiated reviews as well as avoid costly sanctions.  Additional information about Medicaid compliance is also available on the Medicaid Fraud and Abuse and Medicaid e-Library webpages.  On these pages you will find a self-audit guide, an example of a provider self-audit and a Compliance Tips video.