129 hos­pi­tals in au­dit cross hairs

Scott wants Med­i­caid spend­ing checked; 10 lo­cal hos­pi­tals on list.

The Palm Beach Post - - BUSINESS - By Charles El­more Palm Beach Post Staff Writer

Turn­ing up the heat in a health care wran­gle, Gov. Rick Scott says au­dits are jus­ti­fied for 129 Florida hos­pi­tals, in­clud­ing 10 in Palm Beach County, to see if their con­tracts for spend­ing on Med­i­caid pa­tients vi­o­late state law.

“These agree­ments may ul­ti­mately re­sult in over­charg­ing the state for Med­i­caid and other health care ser­vices; and in some in­stances, could con­sti­tute Med­i­caid fraud and even de­cep­tive and un­fair trade prac­tices,” Scott wrote in a let­ter Mon­day to Florida At­tor­ney Gen­eral Pam Bondi.

One group rep­re­sent­ing hos­pi­tals and other South Florida health providers ques­tioned the au­dit cost com­pared with po­ten­tial ben­e­fits, con­sid­er­ing hos­pi­tals are al­ready au­dited regularly in a va­ri­ety of ways.

“This new spe­cial set of state au­dits will re­quire the use of al­ready scarce tax­payer re­sources,” said Linda Quick, pres­i­dent of the South Florida Hos­pi­tal & Healthcare As­so­ci­a­tion. “At the same time, the gover­nor and Leg­is­la­ture has cut the Agency for Health Care Ad­min­is­tra­tion’s bud­get and in­sisted the state can­not af­ford to ex­pand cov­er­age for the unin­sured or pay plans and providers what it costs to pro­vide care and treat­ment to Med­i­caid ben­e­fi­cia­ries.”

Florida Agency for Health Care Ad­min­is­tra­tion spokes­woman She­l­isha Coleman told The Palm Beach Post, “This type of anal­y­sis is within the nor­mal scope of work for the Of­fice of Med­i­caid Pro­gram In­tegrity.”

The de­vel­op­ments un­fold amid a fierce de­bate about whether Florida is ad­e­quately fund­ing Med­i­caid, a fed­eral pro­gram for the poor ad­min­is­tered by states. Med­i­caid HMOs told leg­is­la­tors they needed an ad­di­tional $400 mil­lion to serve peo­ple in man­aged-care pro­grams, and have been in­formed they will get an av­er­age rate in­crease of 7.7 per­cent in 2016.

“We be­lieve that the pay­ments made to hos­pi­tals are ad­e­quate,” Coleman said. “Hos­pi­tals had $45 bil­lion in rev­enue, and a net profit of $4.4 bil­lion in 2014.”

A group rep­re­sent­ing health plans in­volved with hos­pi­tal con­tracts said they will “con­tinue to work with our state part­ners to en­sure they pro­vide qual­ity health care and com­ply with all re­quire­ments in Florida law,” said Au­drey Brown, pres­i­dent of the Florida As­so­ci­a­tion of Health Plans.

Scott said he has di­rected AHCA Sec­re­tary Liz Dudek to have the state’s Of­fice of Med­i­caid Pro­gram In­tegrity be­gin au­dit­ing hos­pi­tals and plans to en­sure con­trac­tual agree­ments for Med­i­caid rates are com­pli­ant with state law. Scott


Gov. Rick Scott has called for an au­dit of Florida hos­pi­tals, in­clud­ing 10 in Palm Beach County. His fo­cus is on con­tracts for Med­i­caid spend­ing that “may ul­ti­mately re­sult in over­charg­ing the state.”

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