HOUSE AMENDMENT

                                                Bill No. CS/HB 507

    Amendment No. 10 (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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  5                                           ORIGINAL STAMP BELOW

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11  Representative(s) Farkas, Fasano, and Brown offered the

12  following:

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14         Amendment to Amendment (121137) (with title amendment) 

15         On page 105, between lines 24 & 25,

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17  insert:

18         Section 101.  Subsection (19) of section 409.913,

19  Florida Statutes, is amended to read:

20         409.913  Oversight of the integrity of the Medicaid

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

22  activities of Florida Medicaid recipients, and providers and

23  their representatives, to ensure that fraudulent and abusive

24  behavior and neglect of recipients occur to the minimum extent

25  possible, and to recover overpayments and impose sanctions as

26  appropriate.

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

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

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

30  or combinations thereof. Appropriate statistical methods may

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

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    File original & 9 copies    03/12/02
    hcs0005                     10:11 am         00507-0052-511057




                                                   HOUSE AMENDMENT

                                                Bill No. CS/HB 507

    Amendment No. 10 (for drafter's use only)





  1  population, parametric and nonparametric statistics, tests of

  2  hypotheses, and other generally accepted statistical methods.

  3  Appropriate analytical methods may include, but are not

  4  limited to, reviews to determine variances between the

  5  quantities of products that a provider had on hand and

  6  available to be purveyed to Medicaid recipients during the

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

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

  9  appropriate consideration sales of the same products to

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

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

12  agency may introduce the results of such statistical methods

13  as evidence of overpayment. A finding of an overpayment or

14  underpayment must be based on the actual overpayment or

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

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

17  of similar orders or refills for similar drugs.

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

21  And the title is amended as follows:

22         On page 116, line 4, of the amendment, after the

23  semicolon,

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25  insert:

26         amending s. 409.913, F.S., to clarify Medicaid

27         determinations of overpayment or underpayment

28         to a provider;

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    File original & 9 copies    03/12/02
    hcs0005                     10:11 am         00507-0052-511057