Lawmakers Postpone Vote After Attorney General Raises Medicaid Fraud Concerns

Jan 19, 2016
Originally published on January 15, 2016 6:05 pm

Lawmakers put the brakes on a Medicaid reimbursement plan this week after Attorney General Pam Bondi attended the bill’s first committee hearing to speak against it.

It’s unusual for an Attorney General to speak publicly against legislation. And even more unusual for the state’s top lawyer to make her points during on a committee hearing on the bill. But Attorney General Pam Bondi says this is an unusual situation.

“In my five years, I’ve never seen anything like this about to happen," Bondi says.

Bondi is talking about a bill filed by Rep. Jay Trumbull (R-Panama City).  It relates to what Bondi says is ongoing and serious litigation.

“This is an end run desperate attempt, not by the representative, an end run desperate attempt in potentially a multimillion dollar case that impacts Florida and other states around the country,” Bondi says.

The case Bondi is talking about has to do with the billing practices of two companies, Quest and Laboratory Corporation of America. The attorney general says she can’t give many details, but does say a lot money hangs in the balance.

In the form of tens of millions of dollars. And again, four states, California alone, they’ve already settled for over $200 million. Nevada settled, other states and the rest of the country they’re looking at us here in Florida. It’s Medicaid fraud, alleged, by Florida, alleged at this point, for overbilling the Medicaid system, meaning our tax payers,” Bondi says.

At the crux of the case is the definition of “usual and customary” – or the typical price a provider charges for a service. Trumbill says his bill would provide clarification.

“Usual and Customary language is a common payment methodology utilized throughout Florida law, however the term is not defined. This creates uncertainty of interpretation of the term and as it relates to Medicaid providers has resulted in litigation, House bill 421 seeks to define usual and customary language for the purposes of Medicaid programs for the providers of independent lab services as the amount routinely billed by a provider or supplier to an uninsured consumer for services and goods before application of any discount, rebate or supplemental plan,” Trumbull says.

Trumbull says he’d like to give lawmakers a chance to define the term instead of letting the courts do it for them. But Bondi says the definition supplied in Trumbel’s bill leaves consumers wide open with few protections.

“By voting yes today, you will be giving these companies an open checkbook to raid our Medicaid program,” Bondi says.

Meanwhile, Michael Hughey, a lobbyist representing Laboratory Corporation of America says the labs he works with haven’t changed the way they bill. The state is making new rules.

“Now why we bring this to you is they are taking a decision out of a first district court of appeals case that relates only to HMOs operating under Chapter 641 and saying that is the new interpretation of Usual and Customary charge that should be applied retroactively, so that they have fraud,” Hughey says.

Hughey says he thinks the legislature, as the holder of the purse strings, should choose a definition.

But lawmakers in the House Health Innovation Committee temporarily postponed a vote on the issue, in order to have more time to gather information. It’s not clear when the measure will come up for a discussion again.

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