Medicaid

Amerigroup

Two major health care groups have named new Chief Operating Officers for their Florida operations.

 Liz Miller has been promoted to the position at WellCare of Florida, the Tampa Bay Business Journal reports. She has been the vice president of product operations at the Tampa-based company since 2012. WellCare is Florida’s large Medicaid HMO contractor.

Pediatricians challenging how the state pays for Medicaid services to children could see the nine-year-old case end in October, the Miami Herald reports.

The lawsuit, filed in 2005, claims that the Agency for Health Care Administration, Department of Health and Department of Children and Families violated federal law, and also hampered patient access by making low Medicaid payments to providers, the Herald reports.

Florida looks to lose more federal money set aside for Medicaid than any state that has opted out of expanding the health care program for the poor, says a new report from the Robert Wood Johnson Foundation and the Urban Institute.

 Several Florida safety net hospitals have filed a complaint claiming the Florida Agency for Health Care Administration underpaid them $73.3 million for Medicare patient care over the past 13 years, the Gainesville Sun reports.

The expansion of Medicaid managed care is the reason for the elimination of 85 state jobs at the Florida Department of Health in Polk County, the Lakeland Ledger reports. Among the positions that will be eliminated are registered nurses, advanced registered nurse practitioners, licensed practical nurses and health support workers. According to the Ledger, 28 of the positions are vacant.   

While many didn’t notice Gov. Rick Scott’s line item veto of funding to investigate Medicaid fraud, the chairman of the Criminal & Civil Justice Appropriations Subcommittee certainly did.

Judge Won't Dismiss Medicaid Lawsuit

Jul 9, 2014
law.fiu.edu

A federal judge refused Tuesday to dismiss a lawsuit that alleges Florida provides inadequate care to children in its Medicaid program, despite state claims that privatizing the program will resolve many of the problems.

Florida’s Agency for Health Care Administration will argue in a hearing today that its new Medicaid managed-care system, which takes full effect next month, should end a legal battle over the quality of care for children in Florida’s Medicaid program. As the News Service of Florida reports, the lawsuit brought by the Florida Pediatric Society says low payment rates mean doctors can’t afford to treat children, thus denying the young Medicaid patients access to physicians. A federal judge will hear the case Tuesday in Miami.

Florida hospitals have just one year to repay $267 million for Medicaid charges the federal government says it shouldn’t have covered during the past eight years, the Times/Herald Tallahassee Bureau reports.

State and hospital officials are asking for three years to pay back the overpayments to hospitals through the so-called Low-Income Pool fund, saying one year would leave them in dire straits.

The federal government has joined a whistleblower lawsuit against a company that provides doctors and other health professionals to work in hospitals in Florida and many other states. IPC The Hospitalist Group operates practice groups in Jacksonville, Ocala, Southwest Florida, Tampa, Broward County, Palm Beach County, Miami-Dade County and Orlando.

Florida can do a better job of caring for its elderly and disabled residents and the loved ones who care for them, a new report says.

The state ranked 43rd nationwide in a new AARP scorecard on long-term care released today, which measured criteria from affordability and access to choice of setting and providers. In particular, Florida placed dead last or near the bottom regarding quality of life and quality of care regarding adults with disabilities.

Shands Health Care System will pay $3.25 million to settle part of a whistle-blower lawsuit claiming six Shands hospitals billed and received overpayments from the government’s Medicare, Medicaid and Tricare programs, the Orlando Sentinel reports.

Medicare Won't Pursue Overpayments

Jun 2, 2014

Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a new report from the inspector general of the U.S. Department of Health and Human Services.

But in its reply to the findings, the Centers for Medicare and Medicaid Services (CMS), which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most expensive visits because it isn't cost effective to do so.

WellCare Health Plans

The interim CEO of WellCare Health Plans says he’s trying to move past the company’s troubles and focus on expanding its Medicare, Medicaid and prescription drug business, the Tampa Bay Times reports.

Dave Gallitano, the WellCare board chairman who led the ouster of the Tampa-based firm's most recent CEO last November, has made significant changes the past six months.

Pediatricians are worried the privatization of the state’s Children’s Medical Services program will leave some children without services, the News Service of Florida reports.

Medicaid coverage for these children changes to pre-paid health plans on Aug. 1. Some pediatricians think the transition has been poorly planned and could leave as many as 70,000 children without medical coverage.

In a column in the Tampa Bay Times, John Romano writes that more than a year ago, lawmakers claimed they were going to look for a solution to help low-income Floridians get health coverage after the House  turned down  a Senate bill to accept $51 billion in federal funds -- money made available through an alternative to  Medicaid expansion under the Affordable Care Act.

With 800,000 uninsured Floridians stuck in the “coverage gap” - too much money to qualify for Medicaid, but not enough for subsidies under the Affordable Care Act - the focus is turning on what can be done to help. 

The Florida Legislature turned down the option of accepting $51 billion in federal funds that would have provided them health coverage last year. With only one week left in this year's session, those in the gap - 20 percent of Florida’s uninsured - will most likely be left hanging.

A Marion County woman accused of defrauding Medicaid said in an affidavit she was caught up in living well and "got greedy," the Ocala Star-Banner reports.

CBS Miami

A plan to redistribute federal money among all of Florida’s hospitals will be delayed at least a year, legislators announced at a joint Health and Human Service budget conference committee meeting on Monday.

The so-called “tiering” plan would be a significant blow to the state’s 14 safety-net hospital systems, such as Miami’s Jackson Health System, which had been bracing for a $140 million cut to its budget, and the state’s two free-standing children’s hospitals, which were prepared to lose a combined $17.6 million.

  All session long, Florida's legislative leaders have frustrated advocates for the poor, as well as much of the business community, by declining to talk about the billions of federal dollars for Medicaid expansion that the state is forgoing.

While 7 million Americans enrolled for health insurance before the March 31 Affordable Care Act deadline,  Charlene Dill wasn’t one of them.

The young mother of three collapsed and died from a treatable heart condition on March 21. She fell into  Florida’s health care gap; her income from part-time commission-based jobs was just $9,000, too poor for Affordable Care Act subsidies, the Orlando Weekly magazine reports.

Medicaid.gov

Florida Medicaid received word Friday evening that federal officials have authorized a $2 billion hospital fund for indigent care starting July 1 and an extra $200 million for the state’s medical schools.

Justin Senior, Florida’s Medicaid director, said the Centers for Medicaid and Medicare Services okayed $2.2 billion for the “Low Income Pool (LIP),” which is used to support “safety-net” hospitals and clinics that treat a lot of Medicaid patients. The LIP is a combination of local and state funds that draw down federal match.

Getting rid of the five-year waiting period for children of legal immigrants to get health coverage through KidCare will improve health outcomes and save money, writes Cindy Arenberg Seltzer, president/CEO of the Children's Services Council of Broward County, in a column in the South Florida Sun Sentinel. Seltzer is urging lawmakers to pass measures that would eliminate the waiting period and give KidCare to more than 25,000 children.  

Florida’s Republican lawmakers remain staunchly opposed to expanding Medicaid — a system they’ve repeatedly said is too expensive and doesn’t improve health outcomes. Yet Florida’s Medicaid rolls are expanding under the Affordable Care Act whether Florida likes it or not.

That’s because people trying to sign up for health insurance under President Obama’s new health law are finding out — to their surprise — that they qualify for Medicaid, the federal health insurance program for the poor.

Broward County Commissioners are considering a $1.29 million incentive package for an unnamed health insurance company wanting to hire 265 employees in Sunrise.

The House Health & Human Services Committee on Thursday approved HB 27, which would take away $200 million in children’s dental services from the Medicaid HMOs and other plans that have already contracted with the state to provide complete medical and dental care for patients of all ages.

The bill, sponsored by state Rep. Jose Diaz, R-Miami, passed 11 to 6.

Does the Affordable Care Act permit the government to seize assets after Medicaid patients age 55 or older die? According to the Florida Times-Union, states have had the option to do that since the Medicaid program started in 1965.

A new drug hailed as a breakthrough against hepatitis C comes at a price that  puts treatment out of reach for most who need the medication -- $84,000 for a standard 12-week course of Sovaldi, manufactured by Gilead Sciences.

Raising hopes that Medicaid expansion isn't as dead as it seems, U.S. Sen. Bill Nelson told Florida House Democrats on Wednesday that he is working on a solution with federal health officials -- but he wouldn't say what it was.

As The Florida Current reports, Nelson also said the state budget for 2014-15, which is being written right now, could lose $600 million in federal funds if the state doesn't compromise. He said it will be "a real shocker," but didn't elaborate.

Florida’s Medicare contractor, First Coast Service Options in Jacksonville, recently announced plans to limit coverage for follow-up drug tests, and is accepting public comment.

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