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FL Blue's Ties to 'Prestige' Contested

A South Florida company that unsuccessfully bid for Medicaid managed care contracts is questioning how a company with financial ties to Florida Blue ended up with contracts in eight of the 11 regions, the Florida Times-Union reports (paywall alert).

Care Access, based in Broward, filed a complaint with the Florida Division of Administrative Hearings after the state Medicaid agency awarded the contracts for “Provider Service Networks” in eight regions to another company, Prestige Health Choice. PSNs are managed-care networks in which health-care providers, such as physician groups or hospitals, have majority control.

The Agency for Health Care Administration, which handles contracting for Medicaid, is required to make at least one PSN available in each of the 11 regions, in addition to one or more HMOs.

Care Access questions whether the negotiating process was truly competitive, in that Florida Blue was competing for Medicaid contracts while also indirectly competing as a part-owner of Prestige Health Choice.  As the Times-Union reports, Florida Blue gained a financial stake in Prestige through “a rapid sequence of corporate maneuverings.”

The specific complaint is focused on the approximately $1-billion contract that serves the region encompassing Miami-Dade and Monroe counties.

Originally founded in December 2006 as an independent grassroots publication dedicated to coverage of health issues in Florida, Health News Florida was acquired by WUSF Public Media in September 2012.