Missouri Medicaid Payment Suspension Defense Law Firm

Missouri Health Care Lawyers

The Law Offices of Kevin J. Dolley represents Missouri health care providers who received Notice of Medicaid Payment Suspension. If you have be advised by the Department of Social Services, Department of Health and Senior Services or other Missouri Department that your Missouri Medicaid number was suspended pursuant to 42 C.F.R. §455.23 and Section 208.164(5) RSMo., attorney Kevin J. Dolley advises that you contact our firm directly to discuss the situation and consider working with our attorneys to file for an immediate stay and injunction before the Missouri Administrative Hearing Commission (AHC).

Missouri Medicaid Law

Missouri law and the AHC regulations allow a health care provider to appeal and under particularized circumstances obtain an immediate stay of the Medicaid payment suspension. The stay order allows a Provider's business to remain in operation while the allegations of billing fraud or irregularities be sorted out and a determination of the issues on the merits decided.

Federal law was recently changed under the Affordable Care Act ("ACA") that now allows the Missouri Medicaid Audit and Compliance Unit to suspend payments to providers under Medicaid prior to an actual adjudication of fraud by a provider. 42 C.F.R. §455.23(a) provides that Missouri Medicaid "may withhold Medicaid payments, in whole or in part, to a provider upon receipt of reliable evidence that the circumstances giving rise to the need for a withholding of payments involve fraud or willful misrepresentation under the Medicaid program."

The changes to this Medicaid provision for suspension of payment create numerous problems and potentially devastating impact on Missouri health care providers. The regulation allows for suspension without any due process hearing to even determine if the suspension is with merit.

Our firm has the knowledge and ability to act swiftly to seek immediate injunctive relief before the AHC in order potentially avoid disruption to billing while the matter can be more appropriately addressed based upon the factual circumstances and the provider being allowed a meaningful defense to the allegations before the AHC or through negotiation with the Medicaid.

There are numerous questions about the changes to the regulation including the vague standards as to how long the suspension lasts and the lack of sufficient notice to providers. The suspension regulation further appears to cloud the standards between mere billing errors and mistakes and the high standard that is required for Medicaid to prove fraud.

If you are a medical provider who received notice of suspension of Medicaid benefits, Mr. Dolley is immediately available to address the situation and seek immediate injunctive relief to allow for Medicaid billing to continue while the matter is addressed on the merits. Please let the firm's legal staff know of the immediacy of the situation and that your case involves a Medicaid suspension. The firm represents medical health care providers such as home health care companies, doctors/physicians, dentists, hospitals, medical equipment providers, pharmacists, nurses, EMTs, ambulance services, anesthesia, medical supplies, laboratories, radiologists, surgery centers, counselors, psychologists, psychiatrists, nursing homes, laboratories, physical therapists, mental health, geriatrics and rehabilitation centers.

Contact a Medicaid Suspension Defense Attorney

Contact Mr. Dolley directly at (314)645-4100 or by email at kevin@dolleylaw.com.