Florida Senate - 2009 COMMITTEE AMENDMENT
Bill No. CS for CS for SB 1986
Barcode 498082
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/15/2009 .
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The Committee on Health and Human Services Appropriations
(Gaetz) recommended the following:
1 Senate Amendment (with directory and title amendments)
2
3 Delete lines 908 - 1039
4 and insert:
5 the start of any investigation or created at the request of
6 the agency.
7 (22) The audit report, supported by agency work papers,
8 showing an overpayment to a provider constitutes evidence of the
9 overpayment. A provider may not present or elicit testimony,
10 either on direct examination or cross-examination in any court
11 or administrative proceeding, regarding the purchase or
12 acquisition by any means of drugs, goods, or supplies; sales or
13 divestment by any means of drugs, goods, or supplies; or
14 inventory of drugs, goods, or supplies, unless such acquisition,
15 sales, divestment, or inventory is documented by written
16 invoices, written inventory records, or other competent written
17 documentary evidence maintained in the normal course of the
18 provider’s business. Notwithstanding the applicable rules of
19 discovery, all documentation that will be offered as evidence at
20 an administrative hearing on a Medicaid overpayment must be
21 exchanged by all parties at least 14 days before the
22 administrative hearing or must be excluded from consideration.
23 The documentation or data that a provider may rely upon or
24 present as evidence that an overpayment has not occurred must
25 have been created prior to the start of any agency investigation
26 and must be made available to the agency before issuance of a
27 final audit report, unless the documentation or data was created
28 at the request of the agency. Documentation or data that was
29 recreated due to extenuating circumstances beyond the provider's
30 control, such as a disaster or the loss of records due to change
31 of ownership, may be presented as evidence if evidence of the
32 extenuating circumstance is also provided. This section shall
33 not be construed to prohibit the introduction of expert witness
34 reports regarding an overpayment or the issues addressed in the
35 audit.
36 (24) If the agency imposes an administrative sanction
37 pursuant to subsection (13), subsection (14), or subsection
38 (15), except paragraphs (15)(e) and (o), upon any provider or
39 any principal, officer, director, agent, managing employee, or
40 affiliated person of the provider other person who is regulated
41 by another state entity, the agency shall notify that other
42 entity of the imposition of the sanction within 5 business days.
43 Such notification must include the provider’s or person’s name
44 and license number and the specific reasons for sanction.
45 (25)(a) The agency shall may withhold Medicaid payments, in
46 whole or in part, to a provider upon receipt of reliable
47 evidence that the circumstances giving rise to the need for a
48 withholding of payments involve fraud, willful
49 misrepresentation, or abuse under the Medicaid program, or a
50 crime committed while rendering goods or services to Medicaid
51 recipients. If it is determined that fraud, willful
52 misrepresentation, abuse, or a crime did not occur, the payments
53 withheld must be paid to the provider within 14 days after such
54 determination with interest at the rate of 10 percent a year.
55 Any money withheld in accordance with this paragraph shall be
56 placed in a suspended account, readily accessible to the agency,
57 so that any payment ultimately due the provider shall be made
58 within 14 days.
59 (b) The agency shall may deny payment, or require
60 repayment, if the goods or services were furnished, supervised,
61 or caused to be furnished by a person who has been suspended or
62 terminated from the Medicaid program or Medicare program by the
63 Federal Government or any state.
64 (c) Overpayments owed to the agency bear interest at the
65 rate of 10 percent per year from the date of determination of
66 the overpayment by the agency, and payment arrangements must be
67 made at the conclusion of legal proceedings. A provider who does
68 not enter into or adhere to an agreed-upon repayment schedule
69 may be terminated by the agency for nonpayment or partial
70 payment.
71 (d) The agency, upon entry of a final agency order, a
72 judgment or order of a court of competent jurisdiction, or a
73 stipulation or settlement, may collect the moneys owed by all
74 means allowable by law, including, but not limited to, notifying
75 any fiscal intermediary of Medicare benefits that the state has
76 a superior right of payment. Upon receipt of such written
77 notification, the Medicare fiscal intermediary shall remit to
78 the state the sum claimed.
79 (e) The agency may institute amnesty programs to allow
80 Medicaid providers the opportunity to voluntarily repay
81 overpayments. The agency may adopt rules to administer such
82 programs.
83 (27) When the Agency for Health Care Administration has
84 made a probable cause determination and alleged that an
85 overpayment to a Medicaid provider has occurred, the agency,
86 after notice to the provider, shall may:
87 (a) Withhold, and continue to withhold during the pendency
88 of an administrative hearing pursuant to chapter 120, any
89 medical assistance reimbursement payments until such time as the
90 overpayment is recovered, unless within 30 days after receiving
91 notice thereof the provider:
92 1. Makes repayment in full; or
93 2. Establishes a repayment plan that is satisfactory to the
94 Agency for Health Care Administration.
95 (b) Withhold, and continue to withhold during the pendency
96 of an administrative hearing pursuant to chapter 120, medical
97 assistance reimbursement payments if the terms of a repayment
98 plan are not adhered to by the provider.
99 (30) The agency shall may terminate a provider’s
100 participation in the Medicaid program if the provider fails to
101 reimburse an overpayment that has been determined by final
102 order, not subject to further appeal, within 35 days after the
103 date of the final order, unless the provider and the agency have
104 entered into a repayment agreement.
105 (31) If a provider requests an administrative hearing
106 pursuant to chapter 120, such hearing must be conducted within
107 90 days following assignment of an administrative law judge,
108 absent exceptionally good cause shown as determined by the
109 administrative law judge or hearing officer. Upon issuance of a
110 final order, the outstanding balance of the amount determined to
111 constitute the overpayment shall become due. If a provider fails
112 to make payments in full, fails to enter into a satisfactory
113 repayment plan, or fails to comply with the terms of a repayment
114 plan or settlement agreement, the agency shall may withhold
115 medical assistance reimbursement payments until the amount due
116 is paid in full.
117 (36) At least three times a year, the agency shall provide
118 to each Medicaid recipient or his or her representative an
119 explanation of benefits in the form of a letter that is mailed
120 to the most recent address of the recipient on the record with
121 the Department of Children and Family Services. The explanation
122 of benefits must include the patient’s name, the name of the
123 health care provider and the address of the location where the
124 service was provided, a description of all services billed to
125 Medicaid in terminology that should be understood by a
126 reasonable person, and information on how to report
127 inappropriate or incorrect billing to the agency or other law
128 enforcement entities for review or investigation. At least once
129 a year, the letter also must include information on how to
130 report criminal Medicaid fraud, the Medicaid Fraud Control
131 Unit’s toll-free hotline number, and information about the
132 rewards available under s. 409.9203. The explanation of benefits
133 may not be mailed for Medicaid independent laboratory services
134 as described in s. 409.905(7) or for Medicaid certified match
135 services as described in ss. 409.9071 and 1011.70.
136 (37) The agency shall post on its website a current list of
137 each Medicaid provider, including any principal, officer,
138 director, agent, managing employee, or affiliated person of the
139 provider, or any partner or shareholder having an ownership
140 interest in the provider equal to 5 percent or greater, who has
141 been terminated from the Medicaid program or sanctioned under
142 this section. The list must be searchable by a variety of search
143 parameters and provide for the creation of formatted lists that
144 may be printed or imported into other applications, including
145 spreadsheets. The agency shall update the list at least monthly.
146 (38) In order to improve the detection of health care
147 fraud, use technology to prevent and detect fraud, and maximize
148 the electronic exchange of health care fraud information, the
149 agency shall:
150 (a) Compile, maintain, and publish on its website a
151 detailed list of all state and federal databases that contain
152 health care fraud information and update the list at least
153 biannually;
154 (b) Develop a strategic plan to connect all databases that
155 contain health care fraud information to facilitate the
156 electronic exchange of health information between the agency,
157 the Department of Health, the Department of Law Enforcement, and
158 the Attorney General’s Office. The plan must include recommended
159 standard data formats, fraud identification strategies, and
160 specifications for the technical interface between state and
161 federal health care fraud databases;
162 (c) Monitor innovations in health information technology,
163 specifically as it pertains to Medicaid fraud prevention and
164 detection; and
165 (d) Periodically publish policy briefs that highlight
166 available new technology to prevent or detect health care fraud
167 and projects implemented by other states, the private sector, or
168 the Federal Government which use technology to prevent or detect
169 health care fraud.
170 ====== D I R E C T O R Y C L A U S E A M E N D M E N T ======
171 And the directory clause is amended as follows:
172 Delete lines 679 - 682
173 and insert:
174 Section 13. Subsections (2), (7), (11), (13), (14), (15),
175 (21), (22), (24), (25), (27), (30), (31), and (36) of section
176 409.913, Florida Statutes, are amended, and subsections (37) and
177 (38) are added to that section, to read:
178
179 ================= T I T L E A M E N D M E N T ================
180 And the title is amended as follows:
181 Delete lines 81 - 96
182 and insert:
183 the Agency for Health Care Administration; providing an
184 exception; requiring that the agency provide notice of certain
185 administrative sanctions to other regulatory agencies within a
186 specified period; requiring the Agency for Health Care
187 Administration to withhold or deny Medicaid payments under
188 certain circumstances; requiring the agency to terminate a
189 provider’s participation in the Medicaid program if the provider
190 fails to repay certain overpayments from the Medicaid program;
191 requiring the agency to provide at least annually information on
192 Medicaid fraud in an explanation of benefits letter; requiring
193 the Agency for Health Care Administration to post a list on its
194 website of Medicaid providers and affiliated persons of
195 providers who have been terminated or sanctioned; requiring the
196 agency to take certain actions to improve the prevention and
197 detection of health care fraud through the use of technology;
198 amending s. 409.920, F.S.; defining the term “managed