Florida neglects to pay medical bills of sickest, needy children
Florida failed for nearly three months to pay tens of thousands of health-care claims for the state’s sickest and neediest children due to software glitches blamed on the corporate merger of its two largest payment vendors, officials and executives said.
Families with critically ill children who relied on Medicaid-paid health providers were stranded in some cases. A father in Lake Worth was forced to cut back his contractor work to remain home and care for his son when payments stopped. A mother in Ocala said the company that helped care for her 15-year-old disabled son temporarily shut down because of the payment problems.
“We had to find caregivers for him,” said AnnMarie Sossong of Ocala, whose son has a neuro-immune condition and profound autism. “You can’t do anything else. You can’t go to work, you can’t go to school, you can’t even make a phone call because you’ve got this kid with such high needs.”
Payment problems panicked more families, especially as unpaid bills for nursing care and other home health services began stacking up over months with no quick resolution in sight.
Executives at Sunshine State Health Plan Inc. of Tampa, Florida’s largest Medicaid payment vendor, said the payment glitches stemmed from the company’s merger on Oct. 1 with the second-largest payment vendor, WellCare of Florida Inc. Combined, Sunshine and Wellcare have multi-year contracts worth $31.6 billion from the state’s Agency for Health Care Administration, according to figures from the state’s chief financial officer.
It was among the most serious technology meltdowns — affecting one of the most vulnerable populations — under the administration of Gov. Ron DeSantis since unemployment claims overwhelmed Florida’s Department of Economic Opportunity early in the pandemic.
“Nobody responded to all these cries for help,” said Lavette Gulley, owner of Serenity Companion Service Inc., which cared for Sossong’s son. She temporarily closed her company due to unpaid invoices, stranding families that relied on the services she provided. “Some of these kids I’ve been with six, seven years, and I never had to call those parents and say, ‘Hey, I’ve got to stop service because I’m not getting paid.’ ”
Dan Miller of Lake Worth is a single father of a 17-year-old son with autism and an electrical contractor. His son’s provider, Blessing Hands Services Inc. of nearby Palm Springs, stopped the family’s services after it went unpaid for months, forcing him to take time from work to care for his son full-time. He said he was at risk financially of losing his family’s home.
“I have jobs right now that I’m in fear of losing because I can’t get to them and can’t get them finished fast enough,” he said. “It’s very bad for me right now financially.”
Sunshine said it realized the scale of the growing issues paying healthcare providers by December, and by January was discussing its serious problems with the Agency for Health Care Administration. The agency confirmed it wasn’t aware of problems until January — and indicated it found out about the problems from others, not Sunshine.
Sunshine said the problems affected children receiving care under its Sunshine Health Medicaid program and the Children’s Medical Services Health Plan it operates on behalf of the Florida Department of Health, for patients under 21 who are eligible for Medicaid and who have serious, chronic conditions.
Gulley, the owner of the health provider Serenity, said payment problems started far earlier than December. She said she was unable to submit claims in late October. In November, she noticed some children who were clients were missing from Sunshine’s system. She said she remained on hold with the company by phone one day for eight hours before the call was disconnected. Parents told her they also were filing grievances with Sunshine over unpaid bills for services for their children.
“At the end of December, I knew I was going to have to shut my doors after 26 years,” Gulley said. She was able to restart her business over the last two weeks.
Frustrated families said they did not blame their children’s health providers who weren’t being paid.
“I don’t know how she’s staying in business,” said Miller, the father in Lake Worth who owns Miller Electric Inc. “I couldn’t go three months without getting any money coming in and still pay payroll if I had somebody working for me.”
The Agency for Health Care Administration said in a statement it was considering “all available recourse options” to punish Sunshine Health — including “liquidated damages and sanctions” — if its investigation determines the company had violated terms of its contract.
The improperly rejected
payments were all re-processed by Jan. 31, Sunshine said. Even though the problems involved its work under a government contract, it declined in interviews to specify the number of families it estimated were affected, the number of healthcare providers whose payments were rejected, the exact number of claims it improperly rejected — or even identify who at the Agency for Health Care Administration it was notifying.
The company said in a statement that “relatively few” providers were affected, representing what it said were one-half of 1% of its 9.2 million total payment claims it processed during the period. That works out to be 46,000 rejected claims, although the figure is believed to be closer to 30,000 rejected claims from about 400 health-care providers.
The company was communicating with the state agency’s Chief of Staff Cody Farrill, who coordinates Medicaid issues with other Florida agencies, the U.S. government and the Legislature. Farill’s office has not yet responded to a Feb. 3 request under Florida’s public records law for copies of emails or other communications he exchanged with Sunshine about the crisis.
Owners of another health provider, The Lamp Post Therapy Center LLC of Gainesville, also said they weren’t paid after the Sunshine corporate merger. It provides occupational and speech therapy services. “It’s been since maybe October when they took over, so that’s a lot of time to go without a paycheck,” CEO Elise Caton said.
The payment problems have drawn almost no public attention. Sunshine acknowledged payment issues in a press release it published on its website Jan. 20, blaming it on an unspecified information-technology problem and not hinting at the scale or seriousness of the issue.