Senate Bill 0562er
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1999 Legislature SB 562, 1st Engrossed
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2 An act relating to Medicaid fraud; amending s.
3 409.910, F.S., relating to Medicaid third-party
4 liability; clarifying that the state may
5 recover and retain damages in excess of
6 Medicaid payments made under certain
7 circumstances; providing for retroactive
8 application; providing an effective date.
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10 Be It Enacted by the Legislature of the State of Florida:
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12 Section 1. (1) Subsection (7) of section 409.910,
13 Florida Statutes, 1998 Supplement, is amended to read:
14 409.910 Responsibility for payments on behalf of
15 Medicaid-eligible persons when other parties are liable.--
16 (7) The department shall recover the full amount of
17 all medical assistance provided by Medicaid on behalf of the
18 recipient to the full extent of third-party benefits.
19 (a) Recovery of such benefits shall be collected
20 directly from:
21 1. Any third party;
22 2. The recipient or legal representative, if he or she
23 has received third-party benefits;
24 3. The provider of a recipient's medical services if
25 third-party benefits have been recovered by the provider;
26 notwithstanding any provision of this section, to the
27 contrary, however, no provider shall be required to refund or
28 pay to the department any amount in excess of the actual
29 third-party benefits received by the provider from a
30 third-party payor for medical services provided to the
31 recipient; or
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1999 Legislature SB 562, 1st Engrossed
1 4. Any person who has received the third-party
2 benefits.
3 (b) Upon receipt of any recovery or other collection
4 pursuant to this section, the department shall distribute the
5 amount collected as follows:
6 1. To itself, an amount equal to the state Medicaid
7 expenditures for the recipient plus any incentive payment made
8 in accordance with paragraph (14)(a).
9 2. To the Federal Government, the federal share of the
10 state Medicaid expenditures minus any incentive payment made
11 in accordance with paragraph (14)(a) and federal law, and
12 minus any other amount permitted by federal law to be
13 deducted.
14 3. To the recipient, after deducting any known amounts
15 owed to the department for any related medical assistance or
16 to health care providers, any remaining amount. This amount
17 shall be treated as income or resources in determining
18 eligibility for Medicaid.
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20 The provisions of this subsection do not apply to any proceeds
21 received by the state, or any agency thereof, pursuant to a
22 final order, judgment, or settlement agreement, in any matter
23 in which the state asserts claims brought on its own behalf,
24 and not as a subrogee of a recipient, or under other theories
25 of liability. The provisions of this subsection do not apply
26 to any proceeds received by the state, or an agency thereof,
27 pursuant to a final order, judgment or settlement agreement,
28 in any matter in which the state asserted both claims as a
29 subrogee and additional claims, except as to those sums
30 specifically identified in the final order, judgment, or
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1999 Legislature SB 562, 1st Engrossed
1 settlement agreement as reimbursements to the recipient as
2 expenditures for the named recipient on the subrogation claim.
3 (2) The amendments to section 409.910, Florida
4 Statutes, 1998 Supplement, provided herein are intended to
5 clarify existing law and are remedial in nature. As such,
6 they are specifically made retroactive to October 1, 1990, and
7 shall apply to all causes of action arising on or after
8 October 1, 1990.
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