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Health News Florida

Florida Hits Managed Care Plans For Damages

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Florida Medicaid officials assessed more than $1 million in damages against all 11 managed health care plans that have contracts with the state, as well as three managed dental care companies.

Florida relies on managed-care companies to provide Medicaid coverage to 3.7 million low-income and elderly residents, but a review of data assembled by regulators shows that the companies have been hit with dozens of complaints that have resulted in the state requesting millions of dollars in payments.

In the first three months of 2021, Florida Medicaid officials assessed more than $1 million in liquidated damages against managed-care plans, according to Agency for Health Care Administration data updated last week.

The state imposed the damages because of 91 alleged violations of Medicaid contracts. The damages were imposed against all 11 managed health-care plans that have contracts with the state, as well as three managed dental-care companies.

The state also imposed damages against Magellan Health for alleged violations during the time frame. Magellan Health offers a Medicaid managed-care specialty plan for people with serious mental illness.

Sunshine Health Plan, which is owned by Centene, had the most complaints --- 11 --- from January to March, resulting in the state assessing $116,500 in damages. A review of the information shows that four of the allegations focused on the adequacy of the plan’s provider network.

While Sunshine Health Plan had the most complaints during the quarter, the state imposed nearly $300,000 in damages --- the highest amount --- against Simply Healthcare. In all, the plan faced eight allegations that it violated its contract with the state. Most of the allegations involved network adequacy requirements, but an allegation that the plan didn’t accurately or timely report information to the state accounted for nearly 33 percent of the overall amount of its liquidated damages, or $98,000.

Records kept by AHCA show that regulators assessed nearly $7 million in liquidated damages against Medicaid managed-care plans between July 1, 2020, and March 30 for 214 alleged contract violations in the first nine months of the 2020-21 fiscal year.

The agency, which runs much of the state’s Medicaid program, has settled 438 alleged contract violations since January 2019, when a new set of managed-care contracts took effect.

The 91 alleged violations from January to March is more than double the number during the same time frame last year, when the COVID-19 pandemic hit the state. The state closed 40 breach-of-contract allegations and imposed $536,000 in liquidated damages from January to March 2020.

According to AHCA's website, state-imposed liquidated damages aren’t meant to be punitive. Instead, they are a projected estimate of the agency’s financial losses and damages as a result of contract breaches.

Generally, managed-care plans don’t have to disclose when a state Medicaid program assesses damages if they are vying to provide services to Medicaid beneficiaries in other states.

The managed care plans do, however, have to disclose if a state imposes sanctions --- which are not the same as liquidated damages --- against them.

A review of the data shows that Florida has not imposed sanctions against any Medicaid managed-care plans since the last six months of the 2018-2019 fiscal year, when it sanctioned Sunshine Health Plan.

Florida lawmakers in 2011 passed an overhaul of the Medicaid program that requires most beneficiaries to enroll in managed-care plans. Medicaid includes about 4.7 million people in Florida.