Agency for Health Care Administration (“AHCA”) is the Florida regulatory entity primarily responsible for the oversight go to the Florida Medicaid program and the licensure of Florida’s health care facilities. AHCA regulates licensed health care facilities (like hospitals), but also those individuals who must enroll or participate in the Florida Medicaid Program.
This article will discuss the disqualifying offenses that can make an individual ineligible to work at AHCA licensed entities and FL Medicaid program ineligibility. Those who are disqualified due their criminal histories, are required to obtain an exemption from disqualification before being allowed to work (or return to work) for an AHCA licensed entity, or before being enrolled (or to be allowed to continue participation) in the Florida Medicaid program.
AHCA licensed health care entities are prohibited from employing any person who cannot pass a Level II background screening. AHCA also requires a Level II background screening for those who must enroll in the Florida Medicaid Program. See S.435.04, Fla. Stat.
The background screening must ensure that the individual has NOT:
for any crime considered a disqualifying offense. See below. Importantly, the statutory language tells us that there is no differentiation between those who have been found guilty and those who have only just been arrested. Meaning that if the individual is pending arrest for a disqualifying offense, they are ineligible.
This is not an exhaustive list. For a full detailed list, please review section 435.04(2)and (3) of the Florida Statutes.
For those seeking employment with an AHCA licensed entity, the above disqualifying offense will prohibit them from gaining employment until they obtain an exemption. See below. The health care entity will be notified of their criminal history and disqualification upon review of the Level II background screening.
For those already employed, and who are arrested thereafter, being arrested for any of the above crimes will result in immediate disqualification from eligibility to work in an AHCA licensed entity. If the arrest occurred in Florida, AHCA should receive notification of ineligibility, generally within a few days, from the law enforcement agency after the individual is fingerprinted and booked. Once AHCA receives notification, they will contact the health care facility to inform them of the individual’s ineligibility. In turn, the health care facility will generally place the employee on suspension and instruct them to resolve the issue through an application for exemption from disqualification. Unfortunately, due to the amount of time needed to obtain an exemption, often employers are forced to terminate employment.
This is not an exhaustive list. For a full detailed list, please review section 435.04 (4) of the Florida Statutes.
For those individuals seeking enrollment, AHCA will be notified of their ineligibility upon review of the Level II background screening. The individual will remain ineligible unless they obtain an exemption. See below.
Individuals who are already enrolled and participating FL Medicaid program will receive correspondence from AHCA notifying them of their ineligibility. The onerous will be on the individual to seek an exemption from disqualification. Unfortunately, due to the length of time is takes to obtain an exemption, disqualification can result in termination. For example, disqualified physician may face hospital discipline and adverse actions against their hospital privileges and medical staff appointments.
Pursuant to Section 435.07 for the Florida Statutes, an individual with a disqualifying offense may be granted an exemption from disqualification. Individuals seeking an exemption have the burden to demonstrate by clear and convincing evidence that an exemption from disqualification should be granted. An individual is not eligible to apply for an Exemption from Disqualification until:
Depending on the individual, the application for exemption from disqualification must either be submitted to AHCA or the Florida Department of Health (“FLDOH”).
Upon receipt of a complete application, the Agency has 30 days to make a decision. A complete application will require, amongst other things, certified records of the applicant’s criminal history. The application will not be considered complete until all necessary, relevant, and requested documents have been received. The Agency may in fact ask for additional information throughout the application process. The Agency will not consider the application until they are satisfied with the documents received.
Because approval of an application for exemption is not guaranteed, health care professionals seeking to obtain an exemption should consult with an experienced health care attorney. An attorney can assist you with identifying successful arguments and evidence that increase the odds of approval. Because the burden of proof lies with the individual, a good application is more than just filling in a form. Both AHCA and FLDOH are tasked with assessment of the moral stature and trustworthiness of the applicant. Some criminal offenses may be difficult to justify and overcome. Furthermore, licensed health care professionals should be mindful that whatever they say to AHCA can be reported to FLDOH and vice versa. [ see our article in re FL licensure disqualifying offenses.
At Chapman Law Group, our attorneys have spent over three decades exclusively representing health care professionals, including those involved in investigations and disciplinary proceedings initiated by the Florida Department of Health. We have successfully defended physicians, nurses, pharmacists, and other licensed providers facing regulatory scrutiny, formal complaints, and emergency actions. Contact Chapman Law Group today to put our specialized knowledge of health care law, administrative investigations, and regulatory compliance to work in protecting your professional license and reputation.
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Chairperson of Professional Licensing & Regulatory Affairs,
Civil Litigation
Sarasota Office
6841 Energy Court
Sarasota, FL 34240
Phone: (941) 893-3449
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