Miami Medicare Lawyer for Healthcare Providers
A Medicare problem in Miami-Dade is rarely just a billing problem. A records request, an additional documentation request or an overpayment demand can turn into a payment suspension, an enrollment revocation or a fraud referral, depending on how the first response is handled. If you run a practice, clinic or healthcare company that bills Medicare, you need a Miami Medicare lawyer involved before you send documents, sign a repayment plan or speak with an investigator.
The Health Law Offices of Anthony C. Vitale, now practicing as Vitale, Suarez & Associates, P.A., has represented healthcare providers from its office in Miami Lakes since 1982. The firm represents providers and healthcare companies, not patients.
Medicare Legal Counsel for Providers in Miami-Dade
Medicare law is not one rule. It is a set of federal statutes, regulations and contractor manuals that decide whether a claim is paid, whether a payment can be kept and whether a provider stays enrolled. The firm advises:
- Physicians and physician groups
- Clinics and ambulatory surgery centers
- Home health agencies and hospices
- DME suppliers, pharmacies and clinical laboratories
- Behavioral health and therapy providers
When a Miami Provider Needs a Medicare Lawyer
- A UPIC or another Medicare contractor sends a records request or an additional documentation request
- A Medicare Administrative Contractor issues an overpayment demand, especially one based on statistical sampling and extrapolation
- Payments are suspended or claims are placed on prepayment review
- Medicare enrollment is denied or revoked, or billing privileges are deactivated
- HHS-OIG, the U.S. Attorney's Office or the Florida Medicaid Fraud Control Unit asks for documents or interviews
- An internal review finds a possible overpayment that may need to be reported and returned
How a Medicare Problem Escalates
A single denied claim is usually a payment issue. A pattern of denied claims is evidence. Once a contractor projects an error rate from a sample to the rest of your claims, the dispute is no longer about a few charts. It is about the mathematical basis of a demand that can reach six or seven figures.
Timing matters. Under 42 C.F.R. § 405.942, a request for redetermination generally must be filed within 120 days of receiving the initial determination, but the window to stop recoupment while the appeal is pending is much shorter. How each deadline applies depends on the date of the notice and the facts of your case. By the time recoupment starts, your options have narrowed.
What you say matters too. An informal explanation to an auditor, such as “our biller handles that” or “the doctor signed later,” becomes part of the record. Your first written response is evidence.
How a Medicare Problem Escalates
- Founded in 1982. The firm has practiced healthcare law from Miami Lakes, in Miami-Dade County, since 1982.
- Prosecution experience. Founder Anthony C. Vitale, now Of Counsel, served as an Assistant State Attorney in Miami-Dade County from 1978 to 1981. Attorney Louis V. Martinez served as Deputy Chief Assistant Attorney General for Florida's Medicaid Fraud Unit and as a Special Assistant United States Attorney for the Southern District of Florida.
- Florida case history. Anthony C. Vitale argued State v. Harden before the Third District Court of Appeal in 2003. In 2006, the Florida Supreme Court struck down section 409.920(2)(e), Florida Statutes, the anti-kickback provision of Florida's Medicaid provider fraud statute, because it conflicted with federal law.
- In-house IT and forensic investigations. The firm's own IT and forensic team reviews EHR audit logs and metadata, with experience in systems such as eClinicalWorks, Avisena and Medios EHR.
- English and Spanish. The firm's attorneys work with clients in both languages.
Strategic Legal Solutions for Healthcare Providers
Serving Healthcare Providers Throughout Miami-Dade
The firm’s office is at 8100 Oak Ln Suite 403 in Miami Lakes. It works with providers in Miami, Hialeah, Doral, Coral Gables, Kendall, Miami Gardens and across Miami-Dade County. Federal Medicare enforcement in Miami-Dade runs through the U.S. Attorney’s Office for the Southern District of Florida. Medicaid matters run through Florida’s Agency for Health Care Administration and the Attorney General’s Medicaid Fraud Control Unit.
Frequently Asked Questions
Do I need a Medicare lawyer for a records request?
Not every request is a crisis, but a UPIC records request is not routine correspondence. What you produce, how you organize it and what you leave out can shape the rest of the review. Speak with counsel before you send anything.
Does the firm represent patients or Medicare beneficiaries?
No. The firm represents healthcare providers and healthcare companies. It does not handle benefit disputes for patients or medical malpractice claims.
What if my Medicare billing privileges were revoked?
A revocation notice comes with short deadlines for a corrective action plan or a reconsideration request, and the notice itself states them. Review it with counsel as soon as it arrives, because a missed deadline can lock in the revocation.
Does the firm only handle Medicare matters?
No. Medicare is one part of the practice. The firm also handles Medicaid, licensure, DEA and healthcare compliance matters for providers in Florida.
The owner of a Tampa, Florida-area medical marketing company was sentenced to 70 months in prison today for his role in a $2.2 million Medicare fraud scheme involving the payment of kickbacks and bribes to fraudulent medical clinics in Miami in exchange for the referral of Medicare beneficiaries for expensive genetic tests that were medically unnecessary, and for his role in the illegal structuring of cash withdrawal transactions.
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Maria Chapa Lopez of the Middle District of Florida, Special Agent in Charge Michael McPherson of the FBI’s Tampa Field Office and Assistant Inspector General Omar Perez of the U.S. Department of Health and Human Services Office of the Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.