Gov. Scott Seeks Medicaid Contract Audits Of Hospitals and Insurers

By  //  August 5, 2015

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Gov. Rick Scott announced earlier this week that Florida will not continue to appeal the Arcia v. Detzner case concerning Florida’s voter rolls.
Gov. Rick Scott is cracking down on hospitals that failed to certify their contracts for Medicaid to comply with state law, and engaging the Agency for Health Care Administration to ensure compliance.

NEWS SERVICE OF FLORIDA – Gov. Rick Scott on Monday directed the state Agency for Health Care Administration (AHCA) to audit at least some contracts between hospitals and health insurers to determine if they comply with a state Medicaid law.

Scott contends that contracts could exceed a legal limit on Medicaid payment rates.

AHCA Secretary Liz Dudek on July 17 requested that hospitals and insurers certify that they did not exceed the limit, which is 120 percent of a Medicaid fee schedule. The letter listed an Aug. 1 deadline to respond.

In a follow-up letter released to the news media Monday, Scott directed Dudek to conduct audits of contracts that had not been certified by Aug. 1 as complying with state law.

Also, he directed Dudek to inform “non-responsive” hospitals and insurers that the state will take action if contracts exceed the 120 percent limit. Such actions would include changing or terminating contracts that are not in compliance with state law.

The follow-up letter did not detail how many contracts might be audited or how many hospitals or insurers were considered non-responsive.

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“Any hospital or insurance plan that did not submit their compliance information to you by your August 1st deadline necessitates immediate further action to ensure taxpayers are not being over-charged due to contracts above and beyond the legal Medicaid rate limit …,” wrote Scott, a former hospital-company CEO.

Also, Scott directed Dudek to make a public presentation on the issue during an Aug. 12 meeting of the state Commission on Healthcare and Hospital Funding, which Scott created this year to delve into financing issues.