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Medicaid and Medicare Revocations & Appeals Attorney in Las Vegas
Medical providers and healthcare professionals in Nevada who participate in Medicaid or Medicare face strict oversight from both state and federal agencies. Allegations of billing irregularities, overpayment, or program violations can lead to revocation or exclusion from these critical healthcare programs. For many providers, these penalties can be career-ending. If you are facing the revocation of your Medicaid or Medicare billing privileges, or if you’ve already received notice of exclusion, Spartacus Law Firm is prepared to fight for your professional future.
Defending Las Vegas Healthcare Providers Accused of Violations
Medicaid and Medicare are essential revenue streams for hospitals, clinics, and independent providers. However, participation in these programs comes with complex regulations and aggressive enforcement. Federal agencies such as the Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) are tasked with identifying fraud, abuse, and non-compliance. In Nevada, the Medicaid Fraud Control Unit (MFCU) may also be involved.
If you’re under investigation or have received notice of potential exclusion or revocation, the time to act is now. Spartacus Law Firm provides skilled legal representation to:
- Physicians
- Nurses
- Behavioral health providers
- Home healthcare agencies
- Dentists
- Durable medical equipment (DME) suppliers
- Mental health professionals
- Any provider enrolled in Medicare or Nevada Medicaid
Common Reasons for Revocation or Exclusion
There are numerous reasons a healthcare provider may face revocation of their Medicare or Medicaid enrollment. The most common include:
- False claims or upcoding
- Billing for services not rendered
- Improper delegation or supervision
- Failure to maintain accurate records
- License suspension or disciplinary actions
- Criminal convictions related to healthcare fraud or controlled substances
- Failure to report adverse legal actions
- Violation of provider agreement terms
Some revocations are based on technical or administrative errors, such as incorrect revalidation filings or missed deadlines. Even minor compliance failures can trigger harsh sanctions.
What Happens When Your Billing Privileges Are Revoked
Once CMS or the Nevada Department of Health and Human Services notifies a provider of revocation, the consequences are immediate and serious. In most cases:
- Your billing privileges are terminated.
- You may be excluded from participation in federal healthcare programs for years.
- You will likely be added to the OIG Exclusion List.
- You may be required to repay funds received during the alleged period of non-compliance.
These actions can destroy a provider’s ability to continue practicing medicine or operating a healthcare business. Even providers who are innocent or made a good-faith error can face these life-altering penalties.
How Spartacus Law Firm Can Help
Our firm understands the stakes involved when your ability to treat patients and earn a living is on the line. Spartacus Law Firm is experienced in defending healthcare professionals facing:
- Medicare and Medicaid revocation hearings
- Administrative appeals
- Requests for reconsideration
- Corrective action plans (CAPs)
- Exclusion list removal
- Negotiations with CMS, OIG, and state agencies
We will conduct a detailed review of your case, identify procedural errors or due process violations, and prepare a defense strategy designed to protect your licensure, reputation, and financial future.
The Appeals Process for Medicare or Medicaid Revocation
Revocations and exclusions are not final. You have the right to contest the decision, but strict deadlines apply. Here is a general overview of the appeals process:
Step 1: Reconsideration
The first step is filing a request for reconsideration. This must be submitted within 60 days of receiving the revocation notice. Spartacus Law Firm will prepare a compelling argument with evidence to demonstrate compliance or justify mitigating factors.
Step 2: Administrative Law Judge (ALJ) Hearing
If reconsideration is denied, you may appeal to an ALJ. This is a formal hearing where evidence and testimony are presented. Legal representation is critical at this stage.
Step 3: Departmental Appeals Board (DAB)
If the ALJ rules against you, the case can be escalated to the DAB. This is the final administrative review.
Step 4: Federal Court Review
In some cases, you may seek judicial review in federal court. Spartacus Law Firm is prepared to take your case as far as necessary to secure justice.
Time Is Critical in These Cases
You must act quickly after receiving a notice of revocation or exclusion. The deadlines to respond are short, and failure to act can forfeit your right to appeal. Our firm will immediately get to work to:
- File the proper notices and documents
- Analyze the factual and legal basis for the action
- Identify possible procedural violations
- Prepare persuasive legal arguments and supporting evidence
We understand the complexities of Medicare and Medicaid regulations and how to challenge the government’s findings with precision and force.
Potential Defenses in Revocation and Exclusion Cases
Every case is unique, but some of the most effective defenses include:
- Demonstrating compliance with billing guidelines
- Providing documentation that contradicts the allegations
- Showing that the conduct was unintentional or corrected promptly
- Challenging the adequacy of notice or procedural fairness
- Arguing that revocation is overly punitive or unsupported by evidence
- Negotiating for corrective action instead of exclusion
Spartacus Law Firm works closely with clients to build the strongest defense possible and explore all available options for resolution.
Why Choose Spartacus Law Firm
Located in Las Vegas, Spartacus Law Firm offers aggressive representation for healthcare providers throughout Nevada. We understand how devastating a revocation or exclusion can be, and we fight hard to keep our clients in practice and in compliance.
- Personalized legal strategy for your case
- In-depth understanding of Nevada Medicaid rules and CMS regulations
- Experience handling provider appeals and administrative law cases
- Skilled negotiator who can engage with government attorneys and regulators
Frequently Asked Questions
What are the most common reasons for Medicaid or Medicare revocation?
Medicaid and Medicare revocations typically occur due to allegations of fraud, billing errors, or failure to comply with program requirements. Common issues include submitting false claims, improper documentation, or being convicted of certain criminal offenses. Even minor administrative mistakes can trigger audits or investigations that may lead to revocation if not addressed quickly and thoroughly.
Can I appeal a Medicare or Medicaid revocation in Nevada?
Yes, healthcare providers in Nevada have the legal right to appeal a Medicare or Medicaid revocation. The appeals process involves multiple levels of review, starting with a reconsideration request and potentially advancing to administrative hearings or federal court. Having an experienced criminal defense lawyer can significantly improve your chances of reversing a revocation or negotiating a favorable resolution.
How long do I have to appeal a Medicare revocation?
You typically have 30 days from the date you receive a revocation notice to file a request for reconsideration. Missing this deadline can permanently forfeit your right to challenge the decision. It’s important to act quickly and consult with a qualified attorney who can ensure your appeal is properly and persuasively submitted.
What are the consequences of being excluded from Medicare or Medicaid?
Exclusion from these programs can have devastating consequences for healthcare providers, including loss of income, damage to professional reputation, and the inability to participate in federally funded healthcare programs. In many cases, exclusion also limits your ability to work with other providers who receive federal funding. Reinstatement is possible but often requires significant legal effort and proof of rehabilitation or compliance.
How can a defense lawyer help in Medicaid or Medicare exclusion cases?
A skilled defense lawyer can help you navigate the complex administrative appeals process, build a strong case backed by documentation and expert analysis, and advocate for your rights in hearings. They can also negotiate with CMS or the Office of Inspector General to reduce penalties or seek early reinstatement. At Spartacus Law Firm, we understand the stakes and provide aggressive legal representation tailored to healthcare professionals facing revocation or exclusion.
Protect Your Future — Contact Spartacus Law Firm Today
A Medicare or Medicaid revocation does not have to end your career. With early intervention and the right legal team, you can challenge the allegations and defend your license, reputation, and practice. Spartacus Law Firm is committed to helping healthcare providers in Las Vegas and across Nevada protect their livelihood.
Call us today to schedule a confidential consultation and get started on your defense.