SENATE AMENDMENT

    Bill No. CS for CS for SB 370

    Amendment No. ___   Barcode 422836

                            CHAMBER ACTION
              Senate                               House
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11  Senator Peaden moved the following amendment:

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13         Senate Amendment (with title amendment) 

14         On page 6, between lines 15 and 16,

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16  insert:

17         Section 2.  Subsection (19) of section 409.913, Florida

18  Statutes, is amended to read:

19         409.913  Oversight of the integrity of the Medicaid

20  program.--The agency shall operate a program to oversee the

21  activities of Florida Medicaid recipients, and providers and

22  their representatives, to ensure that fraudulent and abusive

23  behavior and neglect of recipients occur to the minimum extent

24  possible, and to recover overpayments and impose sanctions as

25  appropriate.

26         (19)  In making a determination of overpayment to a

27  provider, the agency must use accepted and valid auditing,

28  accounting, analytical, statistical, or peer-review methods,

29  or combinations thereof. Appropriate statistical methods may

30  include, but are not limited to, sampling and extension to the

31  population, parametric and nonparametric statistics, tests of

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                                                  SENATE AMENDMENT

    Bill No. CS for CS for SB 370

    Amendment No. ___   Barcode 422836





  1  hypotheses, and other generally accepted statistical methods.

  2  Appropriate analytical methods may include, but are not

  3  limited to, reviews to determine variances between the

  4  quantities of products that a provider had on hand and

  5  available to be purveyed to Medicaid recipients during the

  6  review period and the quantities of the same products paid for

  7  by the Medicaid program for the same period, taking into

  8  appropriate consideration sales of the same products to

  9  non-Medicaid customers during the same period. In meeting its

10  burden of proof in any administrative or court proceeding, the

11  agency may introduce the results of such statistical methods

12  as evidence of overpayment. A finding of overpayment or

13  underpayment must be based on the actual overpayment or

14  underpayment and may not be a projection based on the number

15  of patients served having a similar diagnosis or on the number

16  of similar orders or refills for similar drugs.

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18  (Redesignate subsequent sections.)

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21  ================ T I T L E   A M E N D M E N T ===============

22  And the title is amended as follows:

23         On page 1, line 5, after the semicolon,

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25  insert:

26         amending s. 409.913, F.S.; providing

27         requirements for the Agency for Health Care

28         Administration in making a finding of an

29         overpayment or underpayment to a Medicaid

30         provider;

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