The Doctrine of Exhaustion of Administrative Remedies and Medicare/caid Providers
What is the doctrine of exhaustion of administrative remedies? And why is it important?
If you are a Medicaid or Medicare provider (which, most likely, you are if you are reading this blog), then knowing your administrative remedies is vital. Specifically, you need to know your administrative remedies if you receive an “adverse determination” by the “Department.” I have placed “adverse determination” and the “Department” in quotation marks because these are defined terms in the North Carolina statutes and federal regulations.
What are administrative remedies? If you have been damaged by a decision by a state agency then you have rights to recoup for the damages.
However, just like in the game of Chess, there are rules…procedures to follow…you cannot bring your castle out until the pawn in front of it has moved.
Similarly, you cannot jump to NC Supreme Court without beginning at the lowest court.
What is an adverse determination?
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Posted on September 11, 2015, in "Single State Agency", Administrative Law Judge, Administrative Remedies, Appeal Deadlines, Appeal Rights, Division of Medical Assistance, Due process, Extrapolations, Health Care Providers and Services, Knicole Emanuel, Lawsuit, Legal Analysis, Legal Remedies for Medicaid Providers, Legislation, Medicaid, Medicaid Appeals, Medicaid Attorney, Medicaid Audits, Medicaid Providers, Medicaid Services, Medicare and Medicaid Provider Audits, NC, NC DHHS, NCGS 108C, North Carolina, OAH, Office of Administrative Hearings, Petitions for Contested Cases, Reconsideration Reviews, Regulatory Audits, Suspension of Medicaid Payments and tagged ACA, Administrative Remedies, Appeal prepayment review, appeal recoupments, Audit, Division of Medical Assistance, DMA, Due process, Exhaustion of administrative remedies, Gordon & Rees, Health care, Knicole Emanuel, Medicaid, Medicaid Attorney, Medicaid Attorney; Medicaid Lawyer; Medicare Attorney Medicare Lawyer, Medicaid Audits, Medicaid Services, NC DHHS, NC Medicaid, North Carolina, Post-Payment Review, Post-payment reviews, Prepayment, Prepayment Review, prepayment review attorney, Prepayment Reviews, Tentative Notice of Overpayment. Bookmark the permalink. 1 Comment.