Florida to shut down Medi­care Ad­van­tage plan

Modern Healthcare - - REGIONAL NEWS - —Bob Her­man

Florida will liq­ui­date the as­sets of a Medi­care Ad­van­tage in­surer, end­ing the company’s short and trou­bled his­tory.

The state Depart­ment of Fi­nan­cial Ser­vices took over Florida Health­care Plus this month, and said the in­surer will shut down by Jan. 1. Florida Health­care Plus has been mired in con­tro­versy, in­clud­ing its re­cent run-in with the FBI.

In Novem­ber, the FBI went after 11 peo­ple as­so­ci­ated with Florida Health­care Plus in an elab­o­rate Medi­care fraud scheme that bilked $25.2 mil­lion from the fed­eral gov­ern­ment. In­cluded was Peter Her­nan­dez, the in­surer’s for­mer chief op­er­at­ing of­fi­cer. The FBI said the de­fen­dants sub­mit­ted phony en­roll­ment ap­pli­ca­tions to re­ceive ex­tra cap­i­tated pay­ments from Medi­care, claim­ing some peo­ple lived in Florida when they ac­tu­ally lived in Nicaragua and the Do­mini­can Repub­lic. The company was not charged with wrong­do­ing. Only for­mer em­ploy­ees and those in­volved in the scheme were charged.

The in­surer also at­tracted the ire of the CMS this past year. The company, which had about 9,000 Medi­care Ad­van­tage mem­bers, had to pay a $113,200 fine in July after the CMS found it in­ap­pro­pri­ately de­nied or de­layed care to en­rollees and vi­o­lated sev­eral rules as­so­ci­ated with Medi­care’s Part D drug pro­gram. The CMS even­tu­ally sanc­tioned the in­surer in Septem­ber, say­ing it could not en­roll any new Medi­care mem­bers un­til it rec­ti­fied its er­rors.

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