Medicaid providers in North Carolina are providing an integral service to those in need, but sometimes state officials can get in the way of that important work. We commonly see audits used to damage the reputation of good people and businesses doing honest work.
North Carolina law requires all Medicaid providers to be subject to the same set of rules and treated equally. The audit process is not supposed to be used to single out businesses outside of very specific scenarios. Unfortunately, because Medicaid providers work so closely with the state, officials can sometimes be blinded by other motivations and try to manipulate the market for or against certain providers.
There are two common behaviors we see by the state that abuse the audit process and even put Medicaid providers out of business: Pre-Payment Review and Managed Care Organization (MCO) Contract Termination. These processes aren’t illegal by themselves, but if you feel like you’re being targeted unfairly contact an attorney immediately.
Pre-Payment Review
This type of audit occurs after a Medicaid provider carries out their duties and provides care to an individual or group in need. When providers provide services, they must submit billing to the state to receive payment for those services. It’s during this point in the process that officials frequently initiate audits, unfairly delaying payment to the provider, putting paychecks and stability at risk.
Officials are permitted to do this to ensure the bill is fully accurate and represents the real work done by the provider. The challenge comes when officials use this against smaller providers knowing the temporary delay in funding could put the provider out of business. Bigger providers can also see damages to reputation when audits drag on, sometimes delaying important work.
Managed Care Organization (MCO) Contract Termination
The North Carolina Department of Health and Human Services provides contracts to Medicaid providers to allow them to operate in the state. These contracts need to be renewed, and state law does NOT require the NCDHHS to provide you with a reason a contract was terminated. However, state law DOES specify all providers must be given the same constitutional rights and termination or renewal guidelines must be applied equally.
The challenge to this type of abuse comes when a contract is terminated without reason. State officials can do this to avoid legal liability if a provider suspects their termination was not applied under the same standards other providers were given. Due process is one of your constitutional rights, so your livelihood can’t just be turned upside down without recourse.
Get a lawyer who understands your rights
We want to protect your rights as you do important work in our state of North Carolina. Attorney Ralph Bryant knows the rules and regulations and wants to make sure you are treated fairly as a Medicaid provider. His extensive experience with these cases means he can spot when state officials are being unfair and targeting certain businesses.
Contact us today to better understand your rights and protect your business. We are committed to justice for you.
Medicaid providers in North Carolina are providing an integral service to those in need, but sometimes state officials can get in the way of that important work. We commonly see audits used to damage the reputation of good people and businesses doing honest work.
North Carolina law requires all Medicaid providers to be subject to the same set of rules and treated equally. The audit process is not supposed to be used to single out businesses outside of very specific scenarios. Unfortunately, because Medicaid providers work so closely with the state, officials can sometimes be blinded by other motivations and try to manipulate the market for or against certain providers.
There are two common behaviors we see by the state that abuse the audit process and even put Medicaid providers out of business: Pre-Payment Review and Managed Care Organization (MCO) Contract Termination. These processes aren’t illegal by themselves, but if you feel like you’re being targeted unfairly contact an attorney immediately.
Pre-Payment Review
This type of audit occurs after a Medicaid provider carries out their duties and provides care to an individual or group in need. When providers provide services, they must submit billing to the state to receive payment for those services. It’s during this point in the process that officials frequently initiate audits, unfairly delaying payment to the provider, putting paychecks and stability at risk.
Officials are permitted to do this to ensure the bill is fully accurate and represents the real work done by the provider. The challenge comes when officials use this against smaller providers knowing the temporary delay in funding could put the provider out of business. Bigger providers can also see damages to reputation when audits drag on, sometimes delaying important work.
Managed Care Organization (MCO) Contract Termination
The North Carolina Department of Health and Human Services provides contracts to Medicaid providers to allow them to operate in the state. These contracts need to be renewed, and state law does NOT require the NCDHHS to provide you with a reason a contract was terminated. However, state law DOES specify all providers must be given the same constitutional rights and termination or renewal guidelines must be applied equally.
The challenge to this type of abuse comes when a contract is terminated without reason. State officials can do this to avoid legal liability if a provider suspects their termination was not applied under the same standards other providers were given. Due process is one of your constitutional rights, so your livelihood can’t just be turned upside down without recourse.
Get a lawyer who understands your rights
We want to protect your rights as you do important work in our state of North Carolina. Attorney Ralph Bryant knows the rules and regulations and wants to make sure you are treated fairly as a Medicaid provider. His extensive experience with these cases means he can spot when state officials are being unfair and targeting certain businesses.
Contact us today to better understand your rights and protect your business. We are committed to justice for you.
Ralph Bryant Law Firm
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