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Troubled Plans Top Health News in 2014

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Take a look at the top health care stories in Florida in 2014, and it’s clear that the business of Medicare and Medicaid continued to dominate the news.

Good news -- and plenty of bad, too -- topped the most read stories on Health News Florida in the past year. And yes, the glitches and changes tied to new Affordable Care Act rules created plenty of buzz as well.

The competition over coveted Medicaid managed care contracts was a reader favorite early in the year. Meanwhile, Medicare Advantage plans at the top of their game – and those mired in controversy and financial calamities – were attention getters throughout the year.

Some of these important health stories kept going, long after the first headline caught your attention. And we’ll continue to do our best to keep your updated in 2015. But now, here’s a look back at the top 10 stories of the past year:

1. State Asks to Liquidate Physicians United

(June 6) Florida’s Department of Financial Services on Friday asked a judge to allow a takeover of the troubled Physicians United Medicare Advantage HMO.

The DFS filed a petition in Leon County Circuit Court to place the Orlando-based plan into receivership because it is insolvent. The company’s May financial statement reported assets of $92.4 million, while liabilities amounted to $105.3 million.

2. Prestige Wins Medicaid Contracts 

(Feb. 3) With a billion dollars riding on the contested decision, Florida's Agency for Health Care Administration says it will award its Medicaid managed-care contract for Miami-Dade and Monroe counties to Prestige Health Choice. The final order, signed by AHCA Secretary Liz Dudek on Friday, rejects a recommendation from an administrative law judge who held hearings in the case in November.

The story was a follow up to our eighth most popular story, published almost a month earlier. 

3. FL Medicare Plan Wins 5 Stars

(Oct. 9) Just in time for Medicare's open enrollment season, a Florida-based HMO has won the federal government's coveted five-star rating, a rare honor that brings more than bragging rights. Such plans receive the freedom to enroll new members all year long. The winner, CarePlus Health Plans Inc., is a subsidiary of Humana Inc., Florida's largest Medicare vendor.

4. New Whistleblower Charges at WellCare 

(Nov. 4) WellCare Health Plans, which paid more than $400 million to settle past accusations of health-care fraud, is once again being sued under the False Claims Act.

5.  State Backtracks on Rate Proposals 

This one needs a little explanation, as Health News Florida discovered and wrote about incomplete information within the state’s supposedly transparent reporting of Affordable Care Act-connected health plan information. The initial story revealed a legal loophole that allows insurance companies to withhold certain information if it could be deemed a trade secret. Here's the result:

(June 24) The information posted by health insurers on a state website indicating they would not seek a rate increase for 2015 in Florida's individual market was "incorrect" and has been taken down, the Office of Insurance Regulation said.

This story was in reaction to No Rate Increase? Can It Be?

6. Medicare HMO Fined, Frozen

(Sept. 3) Florida Healthcare Plus, a Medicare HMO and drug plan, is under state review for making a $600,000 error in a financial statement and has been temporarily blocked from enrolling any new members, its chief executive says.

That news was a precursor to our ninth most-popular story.

7. 15 FL Scientists Named 'Most Influential' 

(August 19) A list of "cutting-edge" scientists who have the most influence on their fields -- using citations by other scholars as the yardstick -- includes 15 researchers based in Florida.

While most are known only in their field of study, a handful have made news. One even co-authored a bestseller.

8. Medicaid Contract in Turmoil 

(Jan. 7) Miami-Dade County, the juiciest plum in Florida Medicaid’s switch to mandatory managed care, could still be in play following a ruling against the Agency for Health Care Administration in its contracting decisions. Hundreds of millions of dollars could ride on the outcome.

The decision by Administrative Law Judge John Van Laningham, issued Jan. 2 tells AHCA that it should rescind its decision to award a contract to Prestige Health Choice for the region that encompasses Dade and Monroe counties.

9. Grand Jury Targets Medicare HMO

(Nov. 19) Florida's insurance officials are recommending a state takeover and liquidation of Florida Healthcare Plus, a Medicare Advantage plan accused of submitting $25.2 million in phony bills to Medicare and Florida Medicaid.

A federal grand jury in Miami indicted a doctor and 10 others who worked for the HMO, describing an unusually brazen scam involving enrollment of residents of Nicaragua and the Dominican Republic in the U.S. health care programs. The foreigners were even flown to Miami to further the scheme, according to the U.S. Attorney's Office.

10. Glitch Hits FL Blue Enrollees

(Jan. 16) Florida Blue may have bitten off more than it can chew with its new plans under the Affordable Care Act. The company's customer-service apparatus and computer system appear to be overwhelmed and unable to cope.