Medicaid Administrative Fair Hearings

What are They?

Medical Assistance is a federal program administered at the state level. The federal laws that regulate Medicaid (as it is more commonly known) in most cases require that denials by the state or its MCOs allow for Fair Hearings before administrative law judges. Not every state allows for Fair Hearings, however, and the regulations can be complicated.

However, if a hospital’s or doctor’s claim is denied by a Medicaid payer – whether be it the state’s department of health, or its managed care contractor – then the aggrieved provider may be able to pursue an administrative remedy. In some cases, Anderson & Quinn might need to enlist the patient, who is ultimately the beneficiary of the Medicaid program.

Anderson & Quinn regularly represents the interests of healthcare providers by aligning the interests of the patient with the provider. This is an important role for Anderson & Quinn, and these situations include those scenarios cases whether the applicant for Medicaid benefits is denied by the state or county caseworker due to administrative reasons, such as disqualifications for too many assets or cash.

Why Significant to Providers?

Doctors and hospitals should not let claims or Medicaid benefits remain denied by Medicaid payers. Healthcare providers must pursue every legal recourse available to be paid, especially if the government has already established a legal channel to remedy unfair denials.

What can Anderson & Quinn Do?

Anderson & Quinn evaluates Medicaid denials and determines whether and when these claims should be pursued administratively. When the merits and posture of the case are appropriate, Anderson & Quinn will file an appeal requesting a Fair Hearing.

Whether the issue be a purely technical one (such as a lack of pre-authorization denial) or a clinically-based denial requiring an expert medical opinion, Anderson & Quinn represents healthcare providers in seeking relief through administrative hearings.

Anderson & Quinn Healthcare Attorneys

Rob Scanlon

Rob Scanlon

Managing Member

Gustavo Matheus

Gustavo Matheus


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