Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 1412
Barcode 514478
CHAMBER ACTION
Senate House
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03/08/2006 04:43 PM .
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11 The Committee on Health Care (Peaden) recommended the
12 following amendment:
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14 Senate Amendment (with title amendment)
15 On page 6, lines 14 and 15, delete those lines
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17 and insert: (8) A managed care organization is not liable
18 for the fraud or abuse of an employee or agent unless the
19 officers, directors, or managing agents of the managed care
20 organization actively and knowingly participated in the
21 misconduct or the officers, directors, or managing agents of
22 the managed care organization negligently failed to monitor
23 and prevent activities constituting misconduct.
24 (9) Representatives from managed care organizations,
25 Medicaid, the Office of the Inspector General of the agency,
26 the Medicaid Fraud Control Unit, and the Department of Law
27 Enforcement shall meet at least twice each year to review and
28 discuss fraud and abuse case studies and enforcement matters.
29 (10) Any recovery of funds by the state from a
30 Medicaid provider or recipient representing payment or
31 payments made by a managed care organization compensated by
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 1412
Barcode 514478
1 the state by capitation shall be returned to the capitated
2 managed care organization from which the payment to the
3 Medicaid provider or recipient originated, including interest,
4 if any. The agency, the Medicaid Fraud Control Unit, and the
5 Department of Law Enforcement may not return recovered funds
6 associated with a fraudulent or abusive act committed by an
7 employee or agent of the managed care organization if the
8 officers, directors, or managing agents of the managed care
9 organization actively and knowingly participated in the
10 misconduct or negligently failed to monitor and prevent
11 activities constituting misconduct. Any funds returned to a
12 managed care organization may not include monetary fines,
13 penalties, or sanctions imposed by the agency, the Medicaid
14 Fraud Control Unit, or the Department of Law Enforcement under
15 s. 409.913, that do not represent payment or payments made by
16 a managed care organization. The agency, the Medicaid Fraud
17 Control Unit, and the Department of Law Enforcement may
18 recover investigative, legal, and expert witness costs, if
19 any, under s. 409.913, separate and apart from recovery of
20 payment or payments made by a managed care organization.
21 (11) The Medicaid Fraud Control Unit, in conjunction
22 with managed care organizations, shall track and publish on an
23 annual basis all Medicaid fraud recoveries made under this
24 section.
25 (12) The agency shall develop and promulgate rules to
26 administer this section.
27 (13) Other provisions of law to the contrary
28 notwithstanding, health maintenance organizations under
29 contract with the agency under s. 409.912 or s. 409.91211, are
30 exempt from ss. 626.989 and 626.9891, for Medicaid lines of
31 business.
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1:41 PM 03/06/06 s1412c-he02-tc6
Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 1412
Barcode 514478
1 ================ T I T L E A M E N D M E N T ===============
2 And the title is amended as follows:
3 On page 1, line 28, after the first semicolon
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5 insert:
6 providing that a managed care organization is
7 not liable for the fraud or abuse of an
8 employee or agent under certain circumstances;
9 providing exceptions; providing that any
10 recovery of funds by the state from a Medicaid
11 provider or recipient representing payment or
12 payments made by a managed care organization
13 compensated by the state by capitation shall be
14 returned to the capitated managed care
15 organization from which the payment to the
16 Medicaid provider or recipient originated;
17 providing exceptions; directing the Medicaid
18 Fraud Control Unit, in conjunction with managed
19 care organizations, to track and publish on an
20 annual basis all Medicaid fraud recoveries made
21 under this act;
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