AHCA Licensing & Investigations | Applications, Renewals & Denials (2023)

We have years of experience helping healthcare providers get and keep their license to operate in Florida.

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  • Review letters/documentation from AHCA
  • Assist with the application process
  • Provide advice on how to successfully navigate the system
  • Provide advice on challenging a denial
  • Argue mitigating circumstances which might lessen the penalties
  • Provide advice for dealing financial viability issues
  • Provide representation at formal hearings
  • Assist from beginning to end with change of ownership matters
  • Provide advice & strategies for missed renewal dates.
  • Increase your chances of a successful result with AHCA!

AHCA Licensing & Investigations | Applications, Renewals & Denials (1)

Initial, Renewal & Change of Ownership License Denials in Florida By the Agency for Health Care Administration

Health care providers wanting to do business in Florida face a mountain of regulations and licensing requirements in order to operate. There are three types of license applications: Initial (for first-time applicants), Renewal (for existing licensees) and Change of Ownership or CHOW (existing businesses who are about to be sold to a new owner).

Application for a License Been Denied?

The Agency for Health Care Administration (AHCA) licenses thousands of health care facilities and entities throughout Florida. Licensure is a legal requirement before you can do business in Florida. The process starts by filing with AHCA an Initial Application if you are seeking a first-time license.

(Video) Oral Arguments: Wednesday, December 8, 2021

Once AHCA gets your application it is assigned to a Governmental Analyst, who reviews it for completeness. Is there anything missing? In the great majority of cases, the analyst sends the applicant what is known as an “Omission Letter.” The letter gives you a deadline of approximately 21 or 30 days from the date of the letter to provide additional information or supplement your application. Failure to submit information by the deadline is usually fatal and will result in a denial of your application.

Once you receive a letter or document entitled “Notice of Intent to Deny” you should immediately and without delay contact an experienced health care attorney who represents licensees with this issue. We have found that there is a direct correlation between business people who try and handle this on their own (do it yourself or “DIY) and failure to get the license. Every year numerous individuals try to navigate the bureaucratic maze of AHCA thinking they are saving money, only to be ultimately denied the license.

When the Notice of Intent to Deny is issued you only have 21 days to return the Election of Rights (EOR) to AHCA. Here is where the Do It Yourself crowd goes wrong and loses valuable time and costs their business money: The EOR Form is a trap for the unwary. The form is drawn up by AHCA lawyers and depending upon which option you select you may be unwittingly causing yourself to be denied. Many people think choosing the option to “admit” that certain facts are true is the correct course, but oftentimes the Agency uses this admission to expedite your denial. Conversely, some who are uneducated in the legal process of licensing law elect to “deny” the allegations or challenge the Notice of Intent to Deny. The problem here is that AHCA and the Florida Administrative Code have precise requirements for challenging the denial and it’s not enough to simply check the box. You have to file a formal Petition that meets all the specificity requirements of the law. If you don’t, AHCA quickly rejects your challenge and denies the license based on case law.

If you get a Notice of Denial you should immediately and without delay consult and retain an experienced health care attorney.

Was Your Renewal Application Denied?

Existing healthcare businesses who already have a license need to renew the license with AHCA, usually every two years. A common statement we hear from existing licensees is, “We thought AHCA was going to send us a reminder postcard or letter.We forgot to file our Renewal Application. Now we don’t have a license!” This is a tragedy because everyone should have a calendar marking the date of their renewal or put a sign up in your office so that your management team remembers to send in the application.

If you forget to file a Renewal Application the bad news is that you have no license. If you continue to operate you are not only in violation of the regulatory law but also criminal law. It’s criminal...meaning the ownersandoperators of the business can potentially be fined, put on probation, or imprisoned.

But it doesn’t have to be this way.

  • If you do not file your Renewal Application by the AHCA deadline your license will expire.
  • If AHCA investigators visit your business or have reason to believe you are operating you will get a Cease and Desist Letter with the threat of criminal prosecution.
  • If you continue to operate you run the risk that AHCA will involve your local sheriff in the problem.

We have experience representing clients who have received from AHCA a notice that their license has expired or a Cease and Desist Letter. If this happens to you, it is our professional judgment that you gather the letter and relevant paperwork and contact an experienced health care attorney to handle your case.

There are options but those options become limited if you do not act quickly.

Was your Change of Ownership Application (CHOW) Denied?

Another common myth that business owners believe is that they can simply sell their health care facility or entity to anyone and then the new owner will apply for a license with AHCA. Or the seller wrongly informs the buyer that “You can just file for a renewal of my license once you take over the business.” We are aware of situations where owners incorrectly believe that both are true. It is virtually assured that AHCA will deny your license under these situations.

If AHCA rejects your Change of Ownership application you will receive a Notice of Intent to Deny the License. You have a time deadline to respond. Many of the problems associated with a denial involve situations where AHCA does not believe your application has sufficient proof of financial viability, personnel or owners have failed a background check or not had one at all, missing information or the application for change of ownership was submitted afterthe closing date for the sale of the business.

However, not all is lost! If you encounter such problems you should immediately and without delay contact an experienced health care attorney. There are certain strategies and methods available and in many situations, it’s not too late to recover from this scenario.

Learn more about the Top 5 Change of Ownership Mistakes and how to avoid them.

Was Your Application Denied due to Lack of Proof of Financial Ability to Operate?

In Florida, health care providers and their investors must use caution when preparing an application for initial licensure, renewal or change of ownership with the Agency for Health Care Administration (AHCA). In preparing an application for submission to AHCA the focus must be on:

  • Who can be an owner or have a controlling interest in the health care entity;
  • Are there any background problems with the principal investors or participants;
  • What information must be disclosed on the application; and
  • What steps must be taken to assure that a well-prepared Proof of Financial Ability Form (with supporting documentation) is submitted that is acceptable to AHCA.

Real Case Involving Investor History

A recent case, Roberto Marrero v. AHCA is instructive on this issue. Mr. Marrero owned 100% of the stock in Trust Care Health Services, a home health agency in which he purchased shares. The company was required to file a CHOW (Change of Ownership Application) in order to obtain a new license. Mr. Marrero had previously served as Administrator of All-Med Network Corp., a home health agency, which AHCA had terminated. This company was terminated from Medicare sometime around 2006. Because AHCA determined that the CHOW application did not correctly disclose certain information concerning Mr. Marrero’s prior role in that company, AHCA denied the application. Marrero appealed to the Third District Court of Appeal and argued that although Medicare terminated his former company, he was never personally sanctioned. The Third District Court of Appeal held in favor of AHCA and indicated that the Agency for Health Care Administration did not abuse its discretion.

The Marrero case demonstrates the power of AHCA to deny an application based on officers and/or investors who have previously been affiliated with health care entities that were disqualified from participation in certain governmental programs, namely Medicare and Medicaid. Similarly, other background problems can also disqualify an individual from serving as an officer, investor, or in management.

It is also important to retain qualified and experienced consultants to guide you in preparation for the Proof of Financial Ability. It is advisable to choose preferably a Certified Public Accountant (CPA) with experience handling these matters. Remember, the Agency for Health Care Administration has CPAs on staff to try and prove your estimates of financial ability or viability are inaccurate. It’s much more cost effective to have talented and experienced professionals help you on the front end of the process. Our law firm helps provide the skilled personnel to put your application on the right track!

If you find yourself in one of these scenarios it is strongly advised that you seek an experienced attorney. Individuals at AHCA review 1000s of applications per year and it’s easy to get lost in the shuffle. Put simply, you’re just a number.

We are available for advice, consultation, and representation. If you desire our help we recommend:

Gather all the necessary documentation related to your case. This includes copies of your application, supporting documents, any emails with AHCA officials, letters, and other materials directly related to your efforts to obtain the license.

Schedule a Phone Consultation with our office (850-877-7776). The consultation is free and there is no obligation. We will ask that when you call for a free consultation that you email the relevant documents to us. This is to allow our experienced healthcare attorneys to review the documents prior to the call.

Expedite steps 1 & 2 above as quickly as possible.Time is money! Even if you have missed critical AHCA deadlines it’s important to have the problem reviewed promptly. As time passes you lose valuable opportunities to challenge the Agency’s actions or deploy alternative strategies aimed at getting and keeping your license.

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Why would I get a letter from AHCA? ›

If you are reading this article it means that you have probably received a letter from the Agency for Healthcare Administration (“AHCA”) stating that they have uncovered criminal offenses that disqualify you from working for a health care provider.

How do I contact AHCA background screening? ›

Call the AHCA Background Screening office at(850)412-4503 for further information.

How do I get AHCA licensure in Florida? ›

Licensing Requirements
  1. Application Forms for Initial Licensing. Health Care Clinic Licensing Application. ...
  2. Background Screening.
  3. Medical / Clinic Director.
  4. Proof of Financial Ability to Operate (PFA) ...
  5. Magnetic Resonance Imaging (MRI) Accreditation Requirements. ...
  6. Surety Bond. ...
  7. Survey / Inspection.
  8. Information Required to be Posted.

What is a notice of intent to deny AHCA? ›

A Notice of Intent to Deny Application can also be issued if an applicant does not respond to the ommissions letter within twenty one days after receiving the notice. A Notice of Intent to Deny (reject) Application gives an applicant one last chance to correct errors identified by AHCA in order to receive a license.

What does the Florida AHCA do? ›

Handles health care licensure, Medicare and Medicaid certification, and regulation for hospitals, ambulatory surgical centers, home health agencies, hospices, clinical laboratories, nursing homes, assisted living facilities and all other types of health care providers.

How do I get AHCA Level 2 background check in Florida? ›

The company that is requesting your Level 2 background check has to go on the Agency for Health Care Administration (AHCA/AHCA Medicaid) Clearinghouse web Portal and generate a Level 2 background check request.

What is a Level 2 background check in Florida? ›

Level 2: a state and national fingerprint-based check and consideration of disqualifying offenses and applies to those employees designated by law as holding positions of responsibility or trust.

How can I beat a background check? ›

The first step to passing your background check is to make sure you have a clean credit and bank history. You need to be sure that you've paid your bills on time, and that you aren't behind on any of them. It also helps if you have a good credit score if you're dealing with tenant screening.

Where can I get a copy of my Level 2 background check Florida? ›

The Florida Department of Law Enforcement (FDLE) provides public access to Florida criminal history information. Please visit http://www.fdle.state.fl.us for additional information.

Do you need a license to be a healthcare administrator in Florida? ›

There is no formal licensing requirement for hospital administrators; however, there are established educational paths.

How do I contact AHCA Florida? ›

To file a health care facility complaint, call (888) 419-3456 / (800) 955-8771 Florida Relay Service (TDD number) or complete the Health Care Facility Complaint Form.

Do home health aides need to be licensed in Florida? ›

What kind of license do I need for work as a HHA in Florida? To work as a Home Health Aide in Florida, you will need a 40-hour HHA certificate, a 75-hour Home Health Aide certification (certificate), or a diploma as a Home Health Aide through an approved post-secondary school.

What happens after intent to deny? ›

NOIDs usually take months to process and in some cases, even years. Once the USCIS receives your response, they will begin processing your updated petition. With the new evidence presented to them, they will review your petition and come to a conclusion.

How do you respond to a notice of intent to deny? ›

You must submit your notice of appeal to the office that issued the decision within 30 days from the date of the denial. Note that Form I-290B currently includes a $675 processing fee. After submitting Form I-290B, you will have 21 days to file a written brief in support of your appeal.

What is a notice of denial? ›

Notice of Denial means a written or electronic notice that is issued by the Plan Administrator to a Claimant following an adverse benefit determination which includes any denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, ...

What is required in the Florida Health Care Access Act? ›

The Florida Health Care Access Act allows small businesses to provide group health insurance coverage for its employees on a guarantee-issue basis regardless of health circumstances, preexisting conditions, or claims history.

What is AHCA survey process? ›

During an inspection Agency surveyors review a sampling of clinical records, policies and procedures, staffing reports and other relevant documents. They also conduct interviews with patients/residents, family members, staff, visitors, and/or volunteers.

What is a AHCA Level 2 Florida? ›

Level 2 screening standards set forth in Section 435.04 F.S., requires: “security background investigations as a condition of employment and continued employment which includes, but need not be limited to, fingerprinting for statewide criminal history records checks through the Department of Law Enforcement, and ...

How many years does a Level 2 background check go back in Florida? ›

So how far back does a background check go in Florida at Level 2? Florida has no laws that limit how far back an employer can look into a candidate's past regarding criminal convictions.

How much is AHCA Level 2 background check in Florida? ›

AHCA Background Screening(Agency for Healthcare Administration)Level 2 Background Check-Live Scan includes all healthcare providers – $80.00/Person Includes State & Federal Fees, Taxes, IDENTICO Processing fee.

How much does a Level 2 background check cost in Florida? ›

Level 2 background checks in Florida will either be $37.25 or $61.25 based on your application type, this fee is paid in addition to the rolling or service fee charged by the location offering the Live Scan fingerprinting service.

What disqualifies a Level 2 background check in Florida? ›

Following are some of the disqualifying offenses for a level 2 background check: Sexual misconduct of several types. Murder, manslaughter, homicide, etc. Kidnapping.

How far back does Florida background check go? ›

The FCRA has rules for how far back pre-employment background checks can go in Florida and elsewhere. Under this law, CRAs are forbidden from reporting arrest records that did not result in a conviction to be used for hiring decisions that are more than seven years old.

What is a Level 3 background check in Florida? ›

A Level 3 FACIS background check is the gold standard for exclusion screening, verification, and monitoring. This search includes the entire FACIS database with over 5,000 data sources including historical and state data, millions of individual records, and continuous updates.

What are reasons to fail a background check? ›

What causes a red flag on a background check?
  • Poor employment history.
  • Lying on your resume.
  • Criminal history.
  • Bad references.
  • Poor credit history.
  • Failed substance use test.
  • Bad driving record.
  • Negative social media activity.

What causes a red flag on a background check? ›

If there is a felony on your criminal record, it could be a red flag for employers. A history of violent crimes, sexual offenses, robberies, or serious drug offenses can make it difficult to pass a background check. However, it can still be possible to get a job even if you have a criminal history.

Why won't you pass a background check? ›

What causes a red flag on a background check? There are plenty of reasons a person may not pass a background check, including criminal history, education discrepancies, poor credit history, damaged driving record, false employment history, and a failed drug test.

What is level 2 background check? ›

Level 2 screening is a comprehensive criminal background screening that includes fingerprint-based check for statewide criminal history records through the Florida Department of Law Enforcement and national criminal history records through the Federal Bureau of Investigation.

What is a Tier 2 background investigation? ›

A FIS Tier 2 standard background investigation meets the suitability investigative requirement for non-sensitive positions designated as moderate risk public trust (requested using Standard Form 85P). Investigations conducted at Tiers 2-5 meet the minimum standard for an employee or contractor access to FTI.

What does a Florida background check look for? ›

Background Information Includes: Criminal report, sex offender check, lawsuits, judgments, liens, bankruptcies, home value & property ownership, 30 year address history, relatives & associates, neighbors, marriage records, and more.

How much does a healthcare administrator make with a bachelor degree in Florida? ›

How much does a Health Services Administrator make in Florida? The average Health Services Administrator salary in Florida is $79,282 as of February 27, 2023, but the range typically falls between $70,502 and $88,225.

What is the demand for healthcare administrators in Florida? ›

The state's Department of Economic Opportunity estimates a 25.6 percent increase in jobs for healthcare administrators in the state between 2016 and 2026, slightly above the national average.

Is hospital administration a good career? ›

Improved medical facilities and awareness among the population has led to demand for professionals who can effectively manage a hospital. Government Healthcare Management Jobs are expected to grow by as much as 17% by 2024.

Who is the head of AHCA Florida? ›

Jason C. Weida, Chief of Staff

The Chief of Staff's Office coordinates Medicaid and Health Care Regulation policy with other state agencies, the legislature and the federal government. The office also contains Legislative Affairs, Communications, Information Technology, and the Governor's Washington D.C. Office.

How do I file a complaint with the Florida medical board? ›

File a Complaint
  1. MQA.ConsumerServices@flhealth.gov.
  2. 850-488-0796.
  3. Mailing Address. Department of Health. 4052 Bald Cypress Way, Bin C75. Tallahassee, Florida 32399-3260.
Oct 27, 2022

How do I file a complaint against a medical provider in Florida? ›

To file your complaint, call (888) 419-3456, or complete the Health Care Facility Complaint Form. Your complaint can be filed anonymously, however if you wish to know the results of your complaint, you should be prepared to give your name, address and telephone number.

What are home health aides not allowed to do? ›

Unlicensed caregivers are not allowed to issue medication of any kind, mix medication, fill up reminder boxes, give medical advice, perform medical assessments, or provide medical care.

How much is the pay for HHA in Florida? ›

Where? How much does a Live in home health aide make in Florida? The average live in home health aide salary in Florida is $31,200 per year or $15 per hour. Entry level positions start at $26,325 per year while most experienced workers make up to $97,500 per year.

How many residents can a CNA legally care for in Florida? ›

A minimum of 2.0 hours of direct care by a certified nursing assistant per resident per day. A facility may not staff below one certified nursing assistant per 20 residents.

What are the chances of approval after Noid? ›

It's not easy, and I would say it happens in less than 50% of the cases, probably about 25, 30% of cases can overcome a NOID.

Does Noid get approved? ›

What does a NOID mean for your Green Card application? A Notice of Intent to Deny means that your immigration application or petition has been reviewed by the USCIS and it will not be approved.

What are the reasons for NOID? ›

Common reasons for receiving a NOID include a lack of sufficient documentation provided with an application or petition necessary to meet the legal burden, inconsistencies during an interview at USCIS, or simply a determination that the applicant or petitioner is ineligible for the immigration benefit which is being ...

What is the difference between RFE and NOID? ›

How an RFE differs from a NOID. While a request for evidence tells you that the USCIS cannot evaluate your petition or application in its current form, a NOID is more serious and tells you that USCIS can deny your petition or application in its current form.

What happens if you don't respond to Noid? ›

If an applicant doesn't reply to a NOID, the application will be denied. In comparison, if an applicant doesn't reply to an RFE, a decision will be made on the application based on the evidence that was originally submitted—this may be either a denial or an approval.

What happens after Noid is denied? ›

Receiving the denial notice issued by USCIS means that you are given the opportunity to file a motion to reconsider or reopen, or you can appeal the decision (Form I-290B). The deadline that you will have to meet is 33 days from the decision date. Besides, there is a filing fee of $675.

What are three common reasons for claims denials? ›

Process Errors
  • The claim has missing or incorrect information. Whether by accident or intentionally, medical billing and coding errors are common reasons that claims are rejected or denied. ...
  • The claim was not filed in a timely manner. ...
  • Failure to respond to communication. ...
  • Policy cancelled for lack of premium payment.

What are the two main reasons for denial claims? ›

Incorrect or Missing Patient Information

Manual errors and patient data oversights such as missing or incorrect patient subscriber number, missing date of birth and insurance ineligibility can cause a claim to be denied.

How long after a denial can I apply? ›

How long you should wait to reapply for a credit card after an application is denied varies with each person's situation, so there's no hard-and-fast timeline to follow. The typical recommendation is that you should wait six months between credit card applications.

Why would I get a letter from HHS? ›

The purpose of the notice is to verify the subsidy for the employee and allows you, as an employer, a chance to appeal the eligibility determination of the employee.

What is letter of intent in healthcare? ›

Use an LOI to bridge your intention to purchase a healthcare practice and a legal sales contract. It is a way of making an offer and putting simple terms on the table for the seller. Serious prospective buyers use the LOI in a practice purchase.

Why did I get a letter from Medi Cal? ›

A Medi-Cal NOA is a written notice that gives Medi-Cal applicants and beneficiaries an explanation of their eligibility for Medi-Cal coverage or benefits. The NOA should include the eligibility decision and effective date of coverage, as well as any changes made in your eligibility status or level of benefits.

Did the AHCA pass? ›

The American Health Care Act of 2017 (often shortened to the AHCA or nicknamed Ryancare) was a bill in the 115th United States Congress. The bill, which was passed by the United States House of Representatives but not by the United States Senate, would have partially repealed the Affordable Care Act (ACA).

What is HHS investigation? ›

The Office of Investigations (OI) conducts criminal, civil and administrative investigations of fraud and misconduct related to HHS programs, operations and beneficiaries.

How long does it take to hear back from HHS? ›

Submit your application in USAJobs.gov to the HHS position. The application process can take a few months while HHS reviews the applications and selects candidates for referrals. Complete your onboarding paperwork including background investigation which may take several weeks or more.

Is HHS a federal agency? ›

HHS is the Cabinet-level department of the Federal executive branch most involved with the Nation's human concerns.

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