Florida Senate - 2013                        COMMITTEE AMENDMENT
       Bill No. CS for SB 844
       
       
       
       
       
       
                                Barcode 531582                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/17/2013           .                                
                                       .                                
                                       .                                
                                       .                                
       —————————————————————————————————————————————————————————————————




       —————————————————————————————————————————————————————————————————
       Appropriations Subcommittee on Health and Human Services
       (Grimsley) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraph (c) of subsection (3) of section
    6  409.907, Florida Statutes, is amended, paragraph (k) is added to
    7  that subsection, and subsections (6) through (9) of that section
    8  are amended, to read:
    9         409.907 Medicaid provider agreements.—The agency may make
   10  payments for medical assistance and related services rendered to
   11  Medicaid recipients only to an individual or entity who has a
   12  provider agreement in effect with the agency, who is performing
   13  services or supplying goods in accordance with federal, state,
   14  And local law, and who agrees that no person shall, on the
   15  grounds of handicap, race, color, or national origin, or for any
   16  other reason, be subjected to discrimination under any program
   17  or activity for which the provider receives payment from the
   18  agency.
   19         (3) The provider agreement developed by the agency, in
   20  addition to the requirements specified in subsections (1) and
   21  (2), shall require the provider to:
   22         (c) Retain all medical and Medicaid-related records for 6 a
   23  period of 5 years to satisfy all necessary inquiries by the
   24  agency.
   25         (k) Report a change in any principal of the provider,
   26  including any officer, director, agent, managing employee, or
   27  affiliated person, or any partner or shareholder who has an
   28  ownership interest equal to 5 percent or more in the provider,
   29  to the agency in writing within 30 days after the change occurs.
   30  For a hospital licensed under chapter 395 or a nursing home
   31  licensed under part II of chapter 400, a principal of the
   32  provider is one who meets the definition of a controlling
   33  interest under s. 408.803.
   34         (6) A Medicaid provider agreement may be revoked, at the
   35  option of the agency, due to as the result of a change of
   36  ownership of any facility, association, partnership, or other
   37  entity named as the provider in the provider agreement.
   38         (a) If there is In the event of a change of ownership, the
   39  transferor remains liable for all outstanding overpayments,
   40  administrative fines, and any other moneys owed to the agency
   41  before the effective date of the change of ownership. In
   42  addition to the continuing liability of the transferor, The
   43  transferee is also liable to the agency for all outstanding
   44  overpayments identified by the agency on or before the effective
   45  date of the change of ownership. For purposes of this
   46  subsection, the term “outstanding overpayment” includes any
   47  amount identified in a preliminary audit report issued to the
   48  transferor by the agency on or before the effective date of the
   49  change of ownership. In the event of a change of ownership for a
   50  skilled nursing facility or intermediate care facility, the
   51  Medicaid provider agreement shall be assigned to the transferee
   52  if the transferee meets all other Medicaid provider
   53  qualifications. In the event of a change of ownership involving
   54  a skilled nursing facility licensed under part II of chapter
   55  400, liability for all outstanding overpayments, administrative
   56  fines, and any moneys owed to the agency before the effective
   57  date of the change of ownership shall be determined in
   58  accordance with s. 400.179.
   59         (b) At least 60 days before the anticipated date of the
   60  change of ownership, the transferor must shall notify the agency
   61  of the intended change of ownership and the transferee must
   62  shall submit to the agency a Medicaid provider enrollment
   63  application. If a change of ownership occurs without compliance
   64  with the notice requirements of this subsection, the transferor
   65  and transferee are shall be jointly and severally liable for all
   66  overpayments, administrative fines, and other moneys due to the
   67  agency, regardless of whether the agency identified the
   68  overpayments, administrative fines, or other moneys before or
   69  after the effective date of the change of ownership. The agency
   70  may not approve a transferee’s Medicaid provider enrollment
   71  application if the transferee or transferor has not paid or
   72  agreed in writing to a payment plan for all outstanding
   73  overpayments, administrative fines, and other moneys due to the
   74  agency. This subsection does not preclude the agency from
   75  seeking any other legal or equitable remedies available to the
   76  agency for the recovery of moneys owed to the Medicaid program.
   77  In the event of a change of ownership involving a skilled
   78  nursing facility licensed under part II of chapter 400,
   79  liability for all outstanding overpayments, administrative
   80  fines, and any moneys owed to the agency before the effective
   81  date of the change of ownership shall be determined in
   82  accordance with s. 400.179 if the Medicaid provider enrollment
   83  application for change of ownership is submitted before the
   84  change of ownership.
   85         (c) As used in this subsection, the term:
   86         1. “Administrative fines” includes any amount identified in
   87  a notice of a monetary penalty or fine which has been issued by
   88  the agency or other regulatory or licensing agency that governs
   89  the provider.
   90         2. “Outstanding overpayment” includes any amount identified
   91  in a preliminary audit report issued to the transferor by the
   92  agency on or before the effective date of a change of ownership.
   93         (7) The agency may require, As a condition of participating
   94  in the Medicaid program and before entering into the provider
   95  agreement, the agency may require that the provider to submit
   96  information, in an initial and any required renewal
   97  applications, concerning the professional, business, and
   98  personal background of the provider and permit an onsite
   99  inspection of the provider’s service location by agency staff or
  100  other personnel designated by the agency to perform this
  101  function. Before entering into a provider agreement, the agency
  102  may shall perform an a random onsite inspection, within 60 days
  103  after receipt of a fully complete new provider’s application, of
  104  the provider’s service location prior to making its first
  105  payment to the provider for Medicaid services to determine the
  106  applicant’s ability to provide the services in compliance with
  107  the Medicaid program and professional regulations that the
  108  applicant is proposing to provide for Medicaid reimbursement.
  109  The agency is not required to perform an onsite inspection of a
  110  provider or program that is licensed by the agency, that
  111  provides services under waiver programs for home and community-
  112  based services, or that is licensed as a medical foster home by
  113  the Department of Children and Family Services. As a continuing
  114  condition of participation in the Medicaid program, a provider
  115  must shall immediately notify the agency of any current or
  116  pending bankruptcy filing. Before entering into the provider
  117  agreement, or as a condition of continuing participation in the
  118  Medicaid program, the agency may also require that Medicaid
  119  providers that are reimbursed on a fee-for-services basis or fee
  120  schedule basis that which is not cost-based to, post a surety
  121  bond not to exceed $50,000 or the total amount billed by the
  122  provider to the program during the current or most recent
  123  calendar year, whichever is greater. For new providers, the
  124  amount of the surety bond shall be determined by the agency
  125  based on the provider’s estimate of its first year’s billing. If
  126  the provider’s billing during the first year exceeds the bond
  127  amount, the agency may require the provider to acquire an
  128  additional bond equal to the actual billing level of the
  129  provider. A provider’s bond need shall not exceed $50,000 if a
  130  physician or group of physicians licensed under chapter 458,
  131  chapter 459, or chapter 460 has a 50 percent or greater
  132  ownership interest in the provider or if the provider is an
  133  assisted living facility licensed under chapter 429. The bonds
  134  permitted by this section are in addition to the bonds
  135  referenced in s. 400.179(2)(d). If the provider is a
  136  corporation, partnership, association, or other entity, the
  137  agency may require the provider to submit information concerning
  138  the background of that entity and of any principal of the
  139  entity, including any partner or shareholder having an ownership
  140  interest in the entity equal to 5 percent or greater, and any
  141  treating provider who participates in or intends to participate
  142  in Medicaid through the entity. The information must include:
  143         (a) Proof of holding a valid license or operating
  144  certificate, as applicable, if required by the state or local
  145  jurisdiction in which the provider is located or if required by
  146  the Federal Government.
  147         (b) Information concerning any prior violation, fine,
  148  suspension, termination, or other administrative action taken
  149  under the Medicaid laws or, rules, or regulations of this state
  150  or of any other state or the Federal Government; any prior
  151  violation of the laws or, rules, or regulations relating to the
  152  Medicare program; any prior violation of the rules or
  153  regulations of any other public or private insurer; and any
  154  prior violation of the laws or, rules, or regulations of any
  155  regulatory body of this or any other state.
  156         (c) Full and accurate disclosure of any financial or
  157  ownership interest that the provider, or any principal, partner,
  158  or major shareholder thereof, may hold in any other Medicaid
  159  provider or health care related entity or any other entity that
  160  is licensed by the state to provide health or residential care
  161  and treatment to persons.
  162         (d) If a group provider, identification of all members of
  163  the group and attestation that all members of the group are
  164  enrolled in or have applied to enroll in the Medicaid program.
  165         (8)(a) Each provider, or each principal of the provider if
  166  the provider is a corporation, partnership, association, or
  167  other entity, seeking to participate in the Medicaid program
  168  must submit a complete set of his or her fingerprints to the
  169  agency for the purpose of conducting a criminal history record
  170  check. Principals of the provider include any officer, director,
  171  billing agent, managing employee, or affiliated person, or any
  172  partner or shareholder who has an ownership interest equal to 5
  173  percent or more in the provider. However, for a hospital
  174  licensed under chapter 395 or a nursing home licensed under
  175  chapter 400, principals of the provider are those who meet the
  176  definition of a controlling interest under s. 408.803. A
  177  director of a not-for-profit corporation or organization is not
  178  a principal for purposes of a background investigation as
  179  required by this section if the director: serves solely in a
  180  voluntary capacity for the corporation or organization, does not
  181  regularly take part in the day-to-day operational decisions of
  182  the corporation or organization, receives no remuneration from
  183  the not-for-profit corporation or organization for his or her
  184  service on the board of directors, has no financial interest in
  185  the not-for-profit corporation or organization, and has no
  186  family members with a financial interest in the not-for-profit
  187  corporation or organization; and if the director submits an
  188  affidavit, under penalty of perjury, to this effect to the
  189  agency and the not-for-profit corporation or organization
  190  submits an affidavit, under penalty of perjury, to this effect
  191  to the agency as part of the corporation’s or organization’s
  192  Medicaid provider agreement application. Notwithstanding the
  193  above, the agency may require a background check for any person
  194  reasonably suspected by the agency to have been convicted of a
  195  crime.
  196         (a) This subsection does not apply to:
  197         1. A hospital licensed under chapter 395;
  198         2. A nursing home licensed under chapter 400;
  199         3. A hospice licensed under chapter 400;
  200         4. An assisted living facility licensed under chapter 429;
  201         1.5. A unit of local government, except that requirements
  202  of this subsection apply to nongovernmental providers and
  203  entities contracting with the local government to provide
  204  Medicaid services. The actual cost of the state and national
  205  criminal history record checks must be borne by the
  206  nongovernmental provider or entity; or
  207         2.6. Any business that derives more than 50 percent of its
  208  revenue from the sale of goods to the final consumer, and the
  209  business or its controlling parent is required to file a form
  210  10-K or other similar statement with the Securities and Exchange
  211  Commission or has a net worth of $50 million or more.
  212         (b) Background screening shall be conducted in accordance
  213  with chapter 435 and s. 408.809. The cost of the state and
  214  national criminal record check shall be borne by the provider.
  215         (c) Proof of compliance with the requirements of level 2
  216  screening under chapter 435 conducted within 12 months before
  217  the date the Medicaid provider application is submitted to the
  218  agency fulfills the requirements of this subsection.
  219         (9) Upon receipt of a completed, signed, and dated
  220  application, and completion of any necessary background
  221  investigation and criminal history record check, the agency must
  222  either:
  223         (a) Enroll the applicant as a Medicaid provider upon
  224  approval of the provider application. The enrollment effective
  225  date is shall be the date the agency receives the provider
  226  application. With respect to a provider that requires a Medicare
  227  certification survey, the enrollment effective date is the date
  228  the certification is awarded. With respect to a provider that
  229  completes a change of ownership, the effective date is the date
  230  the agency received the application, the date the change of
  231  ownership was complete, or the date the applicant became
  232  eligible to provide services under Medicaid, whichever date is
  233  later. With respect to a provider of emergency medical services
  234  transportation or emergency services and care, the effective
  235  date is the date the services were rendered. Payment for any
  236  claims for services provided to Medicaid recipients between the
  237  date of receipt of the application and the date of approval is
  238  contingent on applying any and all applicable audits and edits
  239  contained in the agency’s claims adjudication and payment
  240  processing systems. The agency may enroll a provider located
  241  outside this the state of Florida if the provider’s location is
  242  no more than 50 miles from the Florida state line, if the
  243  provider is actively licensed in this state and provides
  244  diagnostic services through telecommunications and information
  245  technology in order to provide clinical health care at a
  246  distance, or if the agency determines a need for that provider
  247  type to ensure adequate access to care; or
  248         (b) Deny the application if the agency finds that it is in
  249  the best interest of the Medicaid program to do so. The agency
  250  may consider the factors listed in subsection (10), as well as
  251  any other factor that could affect the effective and efficient
  252  administration of the program, including, but not limited to,
  253  the applicant’s demonstrated ability to provide services,
  254  conduct business, and operate a financially viable concern; the
  255  current availability of medical care, services, or supplies to
  256  recipients, taking into account geographic location and
  257  reasonable travel time; the number of providers of the same type
  258  already enrolled in the same geographic area; and the
  259  credentials, experience, success, and patient outcomes of the
  260  provider for the services that it is making application to
  261  provide in the Medicaid program. The agency shall deny the
  262  application if the agency finds that a provider; any officer,
  263  director, agent, managing employee, or affiliated person; or any
  264  partner or shareholder having an ownership interest equal to 5
  265  percent or greater in the provider if the provider is a
  266  corporation, partnership, or other business entity, has failed
  267  to pay all outstanding fines or overpayments assessed by final
  268  order of the agency or final order of the Centers for Medicare
  269  and Medicaid Services, not subject to further appeal, unless the
  270  provider agrees to a repayment plan that includes withholding
  271  Medicaid reimbursement until the amount due is paid in full.
  272         Section 2. Subsection (17) of section 409.910, Florida
  273  Statutes, is amended to read:
  274         409.910 Responsibility for payments on behalf of Medicaid
  275  eligible persons when other parties are liable.—
  276         (17) A recipient or his or her legal representative or any
  277  person representing, or acting as agent for, a recipient or the
  278  recipient’s legal representative, who has notice, excluding
  279  notice charged solely by reason of the recording of the lien
  280  pursuant to paragraph (6)(c), or who has actual knowledge of the
  281  agency’s rights to third-party benefits under this section, who
  282  receives any third-party benefit or proceeds therefrom for a
  283  covered illness or injury, must is required either to pay the
  284  agency, within 60 days after receipt of settlement proceeds, pay
  285  the agency the full amount of the third-party benefits, but not
  286  more than in excess of the total medical assistance provided by
  287  Medicaid, or to place the full amount of the third-party
  288  benefits in an interest-bearing a trust account for the benefit
  289  of the agency pending an judicial or administrative
  290  determination of the agency’s right to the benefits thereto.
  291  Proof that any such person had notice or knowledge that the
  292  recipient had received medical assistance from Medicaid, and
  293  that third-party benefits or proceeds therefrom were in any way
  294  related to a covered illness or injury for which Medicaid had
  295  provided medical assistance, and that any such person knowingly
  296  obtained possession or control of, or used, third-party benefits
  297  or proceeds and failed either to pay the agency the full amount
  298  required by this section or to hold the full amount of third
  299  party benefits or proceeds in an interest-bearing trust account
  300  pending an judicial or administrative determination, unless
  301  adequately explained, gives rise to an inference that such
  302  person knowingly failed to credit the state or its agent for
  303  payments received from social security, insurance, or other
  304  sources, pursuant to s. 414.39(4)(b), and acted with the intent
  305  set forth in s. 812.014(1).
  306         (a) A recipient may contest the amount designated as
  307  recovered medical expense damages payable to the agency pursuant
  308  to the formula specified in paragraph (11)(f) by filing a
  309  petition under chapter 120 within 21 days after the date of
  310  payment of funds to the agency or after the date of placing the
  311  full amount of the third-party benefits in the trust account for
  312  the benefit of the agency. The petition shall be filed with the
  313  Division of Administrative Hearings. For purposes of chapter
  314  120, the payment of funds to the agency or the placement of the
  315  full amount of the third-party benefits in the trust account for
  316  the benefit of the agency constitutes final agency action and
  317  notice thereof. Final order authority for the proceedings
  318  specified in this subsection rests with the Division of
  319  Administrative Hearings. This procedure is the exclusive method
  320  for challenging the amount of third-party benefits payable to
  321  the agency.
  322         1. In order to successfully challenge the amount payable to
  323  the agency, the recipient must prove, by clear and convincing
  324  evidence, that a lesser portion of the total recovery should be
  325  allocated as reimbursement for past and future medical expenses
  326  than the amount calculated by the agency pursuant to the formula
  327  set forth in paragraph (11)(f) or that Medicaid provided a
  328  lesser amount of medical assistance than that asserted by the
  329  agency.
  330         2. The agency’s provider processing system reports are
  331  admissible as prima facie evidence in substantiating the
  332  agency’s claim.
  333         3.Venue for all administrative proceedings pursuant to
  334  this subsection lies in Leon County, at the discretion of the
  335  agency. Venue for all appellate proceedings arising from the
  336  administrative proceeding outlined in this subsection lie at the
  337  First District Court of Appeal in Leon County, at the discretion
  338  of the agency.
  339         4. Each party shall bear its own attorney fees and costs
  340  for any administrative proceeding conducted pursuant to this
  341  paragraph.
  342         (b)(a) In cases of suspected criminal violations or
  343  fraudulent activity, the agency may take any civil action
  344  permitted at law or equity to recover the greatest possible
  345  amount, including, without limitation, treble damages under ss.
  346  772.11 and 812.035(7).
  347         1.(b) The agency may is authorized to investigate and to
  348  request appropriate officers or agencies of the state to
  349  investigate suspected criminal violations or fraudulent activity
  350  related to third-party benefits, including, without limitation,
  351  ss. 414.39 and 812.014. Such requests may be directed, without
  352  limitation, to the Medicaid Fraud Control Unit of the Office of
  353  the Attorney General, or to any state attorney. Pursuant to s.
  354  409.913, the Attorney General has primary responsibility to
  355  investigate and control Medicaid fraud.
  356         2.(c) In carrying out duties and responsibilities related
  357  to Medicaid fraud control, the agency may subpoena witnesses or
  358  materials within or outside the state and, through any duly
  359  designated employee, administer oaths and affirmations and
  360  collect evidence for possible use in either civil or criminal
  361  judicial proceedings.
  362         3.(d) All information obtained and documents prepared
  363  pursuant to an investigation of a Medicaid recipient, the
  364  recipient’s legal representative, or any other person relating
  365  to an allegation of recipient fraud or theft is confidential and
  366  exempt from s. 119.07(1):
  367         a.1. Until such time as the agency takes final agency
  368  action;
  369         b.2. Until such time as the Department of Legal Affairs
  370  refers the case for criminal prosecution;
  371         c.3. Until such time as an indictment or criminal
  372  information is filed by a state attorney in a criminal case; or
  373         d.4. At all times if otherwise protected by law.
  374         Section 3. Subsections (9), (13), (15), (16), (21), (22),
  375  (25), (28), (30), and (31) of section 409.913, Florida Statutes,
  376  are amended to read:
  377         409.913 Oversight of the integrity of the Medicaid
  378  program.—The agency shall operate a program to oversee the
  379  activities of Florida Medicaid recipients, and providers and
  380  their representatives, to ensure that fraudulent and abusive
  381  behavior and neglect of recipients occur to the minimum extent
  382  possible, and to recover overpayments and impose sanctions as
  383  appropriate. Beginning January 1, 2003, and each year
  384  thereafter, the agency and the Medicaid Fraud Control Unit of
  385  the Department of Legal Affairs shall submit a joint report to
  386  the Legislature documenting the effectiveness of the state’s
  387  efforts to control Medicaid fraud and abuse and to recover
  388  Medicaid overpayments during the previous fiscal year. The
  389  report must describe the number of cases opened and investigated
  390  each year; the sources of the cases opened; the disposition of
  391  the cases closed each year; the amount of overpayments alleged
  392  in preliminary and final audit letters; the number and amount of
  393  fines or penalties imposed; any reductions in overpayment
  394  amounts negotiated in settlement agreements or by other means;
  395  the amount of final agency determinations of overpayments; the
  396  amount deducted from federal claiming as a result of
  397  overpayments; the amount of overpayments recovered each year;
  398  the amount of cost of investigation recovered each year; the
  399  average length of time to collect from the time the case was
  400  opened until the overpayment is paid in full; the amount
  401  determined as uncollectible and the portion of the uncollectible
  402  amount subsequently reclaimed from the Federal Government; the
  403  number of providers, by type, that are terminated from
  404  participation in the Medicaid program as a result of fraud and
  405  abuse; and all costs associated with discovering and prosecuting
  406  cases of Medicaid overpayments and making recoveries in such
  407  cases. The report must also document actions taken to prevent
  408  overpayments and the number of providers prevented from
  409  enrolling in or reenrolling in the Medicaid program as a result
  410  of documented Medicaid fraud and abuse and must include policy
  411  recommendations necessary to prevent or recover overpayments and
  412  changes necessary to prevent and detect Medicaid fraud. All
  413  policy recommendations in the report must include a detailed
  414  fiscal analysis, including, but not limited to, implementation
  415  costs, estimated savings to the Medicaid program, and the return
  416  on investment. The agency must submit the policy recommendations
  417  and fiscal analyses in the report to the appropriate estimating
  418  conference, pursuant to s. 216.137, by February 15 of each year.
  419  The agency and the Medicaid Fraud Control Unit of the Department
  420  of Legal Affairs each must include detailed unit-specific
  421  performance standards, benchmarks, and metrics in the report,
  422  including projected cost savings to the state Medicaid program
  423  during the following fiscal year.
  424         (9) A Medicaid provider shall retain medical, professional,
  425  financial, and business records pertaining to services and goods
  426  furnished to a Medicaid recipient and billed to Medicaid for 6 a
  427  period of 5 years after the date of furnishing such services or
  428  goods. The agency may investigate, review, or analyze such
  429  records, which must be made available during normal business
  430  hours. However, 24-hour notice must be provided if patient
  431  treatment would be disrupted. The provider must keep is
  432  responsible for furnishing to the agency, and keeping the agency
  433  informed of the location of, the provider’s Medicaid-related
  434  records. The authority of the agency to obtain Medicaid-related
  435  records from a provider is neither curtailed nor limited during
  436  a period of litigation between the agency and the provider.
  437         (13) The agency shall immediately terminate participation
  438  of a Medicaid provider in the Medicaid program and may seek
  439  civil remedies or impose other administrative sanctions against
  440  a Medicaid provider, if the provider or any principal, officer,
  441  director, agent, managing employee, or affiliated person of the
  442  provider, or any partner or shareholder having an ownership
  443  interest in the provider equal to 5 percent or greater, has been
  444  convicted of a criminal offense under federal law or the law of
  445  any state relating to the practice of the provider’s profession,
  446  or a criminal offense listed under s. 408.809(4), s.
  447  409.907(10), or s. 435.04(2) has been:
  448         (a) Convicted of a criminal offense related to the delivery
  449  of any health care goods or services, including the performance
  450  of management or administrative functions relating to the
  451  delivery of health care goods or services;
  452         (b) Convicted of a criminal offense under federal law or
  453  the law of any state relating to the practice of the provider’s
  454  profession; or
  455         (c) Found by a court of competent jurisdiction to have
  456  neglected or physically abused a patient in connection with the
  457  delivery of health care goods or services. If the agency
  458  determines that the a provider did not participate or acquiesce
  459  in the an offense specified in paragraph (a), paragraph (b), or
  460  paragraph (c), termination will not be imposed. If the agency
  461  effects a termination under this subsection, the agency shall
  462  take final agency action issue an immediate final order pursuant
  463  to s. 120.569(2)(n).
  464         (15) The agency shall seek a remedy provided by law,
  465  including, but not limited to, any remedy provided in
  466  subsections (13) and (16) and s. 812.035, if:
  467         (a) The provider’s license has not been renewed, or has
  468  been revoked, suspended, or terminated, for cause, by the
  469  licensing agency of any state;
  470         (b) The provider has failed to make available or has
  471  refused access to Medicaid-related records to an auditor,
  472  investigator, or other authorized employee or agent of the
  473  agency, the Attorney General, a state attorney, or the Federal
  474  Government;
  475         (c) The provider has not furnished or has failed to make
  476  available such Medicaid-related records as the agency has found
  477  necessary to determine whether Medicaid payments are or were due
  478  and the amounts thereof;
  479         (d) The provider has failed to maintain medical records
  480  made at the time of service, or prior to service if prior
  481  authorization is required, demonstrating the necessity and
  482  appropriateness of the goods or services rendered;
  483         (e) The provider is not in compliance with provisions of
  484  Medicaid provider publications that have been adopted by
  485  reference as rules in the Florida Administrative Code; with
  486  provisions of state or federal laws, rules, or regulations; with
  487  provisions of the provider agreement between the agency and the
  488  provider; or with certifications found on claim forms or on
  489  transmittal forms for electronically submitted claims that are
  490  submitted by the provider or authorized representative, as such
  491  provisions apply to the Medicaid program;
  492         (f) The provider or person who ordered, authorized, or
  493  prescribed the care, services, or supplies has furnished, or
  494  ordered or authorized the furnishing of, goods or services to a
  495  recipient which are inappropriate, unnecessary, excessive, or
  496  harmful to the recipient or are of inferior quality;
  497         (g) The provider has demonstrated a pattern of failure to
  498  provide goods or services that are medically necessary;
  499         (h) The provider or an authorized representative of the
  500  provider, or a person who ordered, authorized, or prescribed the
  501  goods or services, has submitted or caused to be submitted false
  502  or a pattern of erroneous Medicaid claims;
  503         (i) The provider or an authorized representative of the
  504  provider, or a person who has ordered, authorized, or prescribed
  505  the goods or services, has submitted or caused to be submitted a
  506  Medicaid provider enrollment application, a request for prior
  507  authorization for Medicaid services, a drug exception request,
  508  or a Medicaid cost report that contains materially false or
  509  incorrect information;
  510         (j) The provider or an authorized representative of the
  511  provider has collected from or billed a recipient or a
  512  recipient’s responsible party improperly for amounts that should
  513  not have been so collected or billed by reason of the provider’s
  514  billing the Medicaid program for the same service;
  515         (k) The provider or an authorized representative of the
  516  provider has included in a cost report costs that are not
  517  allowable under a Florida Title XIX reimbursement plan, after
  518  the provider or authorized representative had been advised in an
  519  audit exit conference or audit report that the costs were not
  520  allowable;
  521         (l) The provider is charged by information or indictment
  522  with fraudulent billing practices or an offense referenced in
  523  subsection (13). The sanction applied for this reason is limited
  524  to suspension of the provider’s participation in the Medicaid
  525  program for the duration of the indictment unless the provider
  526  is found guilty pursuant to the information or indictment;
  527         (m) The provider or a person who has ordered, authorized,
  528  or prescribed the goods or services is found liable for
  529  negligent practice resulting in death or injury to the
  530  provider’s patient;
  531         (n) The provider fails to demonstrate that it had available
  532  during a specific audit or review period sufficient quantities
  533  of goods, or sufficient time in the case of services, to support
  534  the provider’s billings to the Medicaid program;
  535         (o) The provider has failed to comply with the notice and
  536  reporting requirements of s. 409.907;
  537         (p) The agency has received reliable information of patient
  538  abuse or neglect or of any act prohibited by s. 409.920; or
  539         (q) The provider has failed to comply with an agreed-upon
  540  repayment schedule.
  541  
  542  A provider is subject to sanctions for violations of this
  543  subsection as the result of actions or inactions of the
  544  provider, or actions or inactions of any principal, officer,
  545  director, agent, managing employee, or affiliated person of the
  546  provider, or any partner or shareholder having an ownership
  547  interest in the provider equal to 5 percent or greater, in which
  548  the provider participated or acquiesced.
  549         (16) The agency shall impose any of the following sanctions
  550  or disincentives on a provider or a person for any of the acts
  551  described in subsection (15):
  552         (a) Suspension for a specific period of time of not more
  553  than 1 year. Suspension precludes shall preclude participation
  554  in the Medicaid program, which includes any action that results
  555  in a claim for payment to the Medicaid program for as a result
  556  of furnishing, supervising a person who is furnishing, or
  557  causing a person to furnish goods or services.
  558         (b) Termination for a specific period of time ranging of
  559  from more than 1 year to 20 years. Termination precludes shall
  560  preclude participation in the Medicaid program, which includes
  561  any action that results in a claim for payment to the Medicaid
  562  program for as a result of furnishing, supervising a person who
  563  is furnishing, or causing a person to furnish goods or services.
  564         (c) Imposition of a fine of up to $5,000 for each
  565  violation. Each day that an ongoing violation continues, such as
  566  refusing to furnish Medicaid-related records or refusing access
  567  to records, is considered, for the purposes of this section, to
  568  be a separate violation. Each instance of improper billing of a
  569  Medicaid recipient; each instance of including an unallowable
  570  cost on a hospital or nursing home Medicaid cost report after
  571  the provider or authorized representative has been advised in an
  572  audit exit conference or previous audit report of the cost
  573  unallowability; each instance of furnishing a Medicaid recipient
  574  goods or professional services that are inappropriate or of
  575  inferior quality as determined by competent peer judgment; each
  576  instance of knowingly submitting a materially false or erroneous
  577  Medicaid provider enrollment application, request for prior
  578  authorization for Medicaid services, drug exception request, or
  579  cost report; each instance of inappropriate prescribing of drugs
  580  for a Medicaid recipient as determined by competent peer
  581  judgment; and each false or erroneous Medicaid claim leading to
  582  an overpayment to a provider is considered, for the purposes of
  583  this section, to be a separate violation.
  584         (d) Immediate suspension, if the agency has received
  585  information of patient abuse or neglect or of any act prohibited
  586  by s. 409.920. Upon suspension, the agency must issue an
  587  immediate final order under s. 120.569(2)(n).
  588         (e) A fine, not to exceed $10,000, for a violation of
  589  paragraph (15)(i).
  590         (f) Imposition of liens against provider assets, including,
  591  but not limited to, financial assets and real property, not to
  592  exceed the amount of fines or recoveries sought, upon entry of
  593  an order determining that such moneys are due or recoverable.
  594         (g) Prepayment reviews of claims for a specified period of
  595  time.
  596         (h) Comprehensive followup reviews of providers every 6
  597  months to ensure that they are billing Medicaid correctly.
  598         (i) Corrective-action plans that would remain in effect for
  599  providers for up to 3 years and that are would be monitored by
  600  the agency every 6 months while in effect.
  601         (j) Other remedies as permitted by law to effect the
  602  recovery of a fine or overpayment.
  603  
  604  If a provider voluntarily relinquishes its Medicaid provider
  605  number or an associated license, or allows the associated
  606  licensure to expire after receiving written notice that the
  607  agency is conducting, or has conducted, an audit, survey,
  608  inspection, or investigation and that a sanction of suspension
  609  or termination will or would be imposed for noncompliance
  610  discovered as a result of the audit, survey, inspection, or
  611  investigation, the agency shall impose the sanction of
  612  termination for cause against the provider. The Secretary of
  613  Health Care Administration may make a determination that
  614  imposition of a sanction or disincentive is not in the best
  615  interest of the Medicaid program, in which case a sanction or
  616  disincentive may shall not be imposed.
  617         (21) When making a determination that an overpayment has
  618  occurred, the agency shall prepare and issue an audit report to
  619  the provider showing the calculation of overpayments. The
  620  agency’s determination must be based solely upon information
  621  available to it before issuance of the audit report and, in the
  622  case of documentation obtained to substantiate claims for
  623  Medicaid reimbursement, based solely upon contemporaneous
  624  records.
  625         (22) The audit report, supported by agency work papers,
  626  showing an overpayment to a provider constitutes evidence of the
  627  overpayment. A provider may not present or elicit testimony,
  628  either on direct examination or cross-examination in any court
  629  or administrative proceeding, regarding the purchase or
  630  acquisition by any means of drugs, goods, or supplies; sales or
  631  divestment by any means of drugs, goods, or supplies; or
  632  inventory of drugs, goods, or supplies, unless such acquisition,
  633  sales, divestment, or inventory is documented by written
  634  invoices, written inventory records, or other competent written
  635  documentary evidence maintained in the normal course of the
  636  provider’s business. A provider may not present records to
  637  contest an overpayment or sanction unless such records are
  638  contemporaneous and, if requested during the audit process, were
  639  furnished to the agency or its agent upon request. This
  640  limitation does not apply to Medicaid cost report audits.
  641  Notwithstanding the applicable rules of discovery, all
  642  documentation to that will be offered as evidence at an
  643  administrative hearing on a Medicaid overpayment or an
  644  administrative sanction must be exchanged by all parties at
  645  least 14 days before the administrative hearing or must be
  646  excluded from consideration.
  647         (25)(a) The agency shall withhold Medicaid payments, in
  648  whole or in part, to a provider upon receipt of reliable
  649  evidence that the circumstances giving rise to the need for a
  650  withholding of payments involve fraud, willful
  651  misrepresentation, or abuse under the Medicaid program, or a
  652  crime committed while rendering goods or services to Medicaid
  653  recipients. If it is determined that fraud, willful
  654  misrepresentation, abuse, or a crime did not occur, the payments
  655  withheld must be paid to the provider within 14 days after such
  656  determination with interest at the rate of 10 percent a year.
  657  Amounts not paid within 14 days accrue interest at the rate of
  658  10 percent a year, beginning after the 14th day Any money
  659  withheld in accordance with this paragraph shall be placed in a
  660  suspended account, readily accessible to the agency, so that any
  661  payment ultimately due the provider shall be made within 14
  662  days.
  663         (b) The agency shall deny payment, or require repayment, if
  664  the goods or services were furnished, supervised, or caused to
  665  be furnished by a person who has been suspended or terminated
  666  from the Medicaid program or Medicare program by the Federal
  667  Government or any state.
  668         (c) Overpayments owed to the agency bear interest at the
  669  rate of 10 percent per year from the date of final determination
  670  of the overpayment by the agency, and payment arrangements must
  671  be made within 30 days after the date of the final order, which
  672  is not subject to further appeal at the conclusion of legal
  673  proceedings. A provider who does not enter into or adhere to an
  674  agreed-upon repayment schedule may be terminated by the agency
  675  for nonpayment or partial payment.
  676         (d) The agency, upon entry of a final agency order, a
  677  judgment or order of a court of competent jurisdiction, or a
  678  stipulation or settlement, may collect the moneys owed by all
  679  means allowable by law, including, but not limited to, notifying
  680  any fiscal intermediary of Medicare benefits that the state has
  681  a superior right of payment. Upon receipt of such written
  682  notification, the Medicare fiscal intermediary shall remit to
  683  the state the sum claimed.
  684         (e) The agency may institute amnesty programs to allow
  685  Medicaid providers the opportunity to voluntarily repay
  686  overpayments. The agency may adopt rules to administer such
  687  programs.
  688         (28) Venue for all Medicaid program integrity overpayment
  689  cases lies shall lie in Leon County, at the discretion of the
  690  agency.
  691         (30) The agency shall terminate a provider’s participation
  692  in the Medicaid program if the provider fails to reimburse an
  693  overpayment or pay an agency-imposed fine that has been
  694  determined by final order, not subject to further appeal, within
  695  30 35 days after the date of the final order, unless the
  696  provider and the agency have entered into a repayment agreement.
  697         (31) If a provider requests an administrative hearing
  698  pursuant to chapter 120, such hearing must be conducted within
  699  90 days following assignment of an administrative law judge,
  700  absent exceptionally good cause shown as determined by the
  701  administrative law judge or hearing officer. Upon issuance of a
  702  final order, the outstanding balance of the amount determined to
  703  constitute the overpayment and fines is shall become due. If a
  704  provider fails to make payments in full, fails to enter into a
  705  satisfactory repayment plan, or fails to comply with the terms
  706  of a repayment plan or settlement agreement, the agency shall
  707  withhold medical assistance reimbursement payments for Medicaid
  708  services until the amount due is paid in full.
  709         Section 4. Subsection (8) of section 409.920, Florida
  710  Statutes, is amended to read:
  711         409.920 Medicaid provider fraud.—
  712         (8) A person who provides the state, any state agency, any
  713  of the state’s political subdivisions, or any agency of the
  714  state’s political subdivisions with information about fraud or
  715  suspected fraudulent acts fraud by a Medicaid provider,
  716  including a managed care organization, is immune from civil
  717  liability for libel, slander, or any other relevant tort for
  718  providing the information about fraud or suspected fraudulent
  719  acts unless the person acted with knowledge that the information
  720  was false or with reckless disregard for the truth or falsity of
  721  the information. Such immunity extends to reports of fraudulent
  722  acts or suspected fraudulent acts conveyed to or from the agency
  723  in any manner, including any forum and with any audience as
  724  directed by the agency, and includes all discussions subsequent
  725  to the report and subsequent inquiries from the agency, unless
  726  the person acted with knowledge that the information was false
  727  or with reckless disregard for the truth or falsity of the
  728  information. As used in this subsection, the term “fraudulent
  729  acts” includes actual or suspected fraud and abuse, insurance
  730  fraud, licensure fraud, or public assistance fraud, including
  731  any fraud-related matters that a provider or health plan is
  732  required to report to the agency or a law enforcement agency.
  733         Section 5. Subsection (3) of section 624.351, Florida
  734  Statutes, is amended, and subsection (8) is added to that
  735  section, to read:
  736         624.351 Medicaid and Public Assistance Fraud Strike Force.—
  737         (3) MEMBERSHIP.—The strike force shall consist of the
  738  following 11 members or their designees. A designee shall serve
  739  in the same capacity as the designating member who may not
  740  designate anyone to serve in their place:
  741         (a) The Chief Financial Officer, who shall serve as chair.
  742         (b) The Attorney General, who shall serve as vice chair.
  743         (c) The executive director of the Department of Law
  744  Enforcement.
  745         (d) The Secretary of Health Care Administration.
  746         (e) The Secretary of Children and Family Services.
  747         (f) The State Surgeon General.
  748         (g) Five members appointed by the Chief Financial Officer,
  749  consisting of two sheriffs, two chiefs of police, and one state
  750  attorney. When making these appointments, the Chief Financial
  751  Officer shall consider representation by geography, population,
  752  ethnicity, and other relevant factors in order to ensure that
  753  the membership of the strike force is representative of the
  754  state as a whole.
  755         (8) EXPIRATION.—This section is repealed June 30, 2014.
  756         Section 6. Subsection (3) is added to section 624.352,
  757  Florida Statutes, to read:
  758         624.352 Interagency agreements to detect and deter Medicaid
  759  and public assistance fraud.—
  760         (3) This section is repealed June 30, 2014.
  761         Section 7. This act shall take effect July 1, 2013.
  762  
  763  ================= T I T L E  A M E N D M E N T ================
  764         And the title is amended as follows:
  765         Delete everything before the enacting clause
  766  and insert:
  767                        A bill to be entitled                      
  768         An act relating to Medicaid; amending s. 409.907,
  769         F.S.; increasing the number of years a provider must
  770         keep records; adding an additional provision relating
  771         to a change in principal that must be included in a
  772         Medicaid provider agreement with the Agency for Health
  773         Care Administration; adding the definitions of the
  774         terms “administrative fines” and “outstanding
  775         overpayment”; revising provisions relating to the
  776         agency’s onsite inspection responsibilities; revising
  777         provisions relating to who is subject to background
  778         screening; authorizing the agency to enroll a provider
  779         who is licensed in this state and provides diagnostic
  780         services through telecommunications technology;
  781         amending s. 409.910, F.S.; revising provisions
  782         relating to responsibility for Medicaid payments in
  783         settlement proceedings; providing procedures for a
  784         recipient to contest the amount payable to the agency;
  785         amending s. 409.913, F.S.; increasing the number of
  786         years a provider must keep records; revising
  787         provisions specifying grounds for terminating a
  788         provider from the program, for seeking certain
  789         remedies for violations, and for imposing certain
  790         sanctions; providing a limitation on the information
  791         the agency may consider when making a determination of
  792         overpayment; specifying the type of records a provider
  793         must present to contest an overpayment; deleting the
  794         requirement that the agency place payments withheld
  795         from a provider in a suspended account and revising
  796         when a provider must reimburse overpayments; revising
  797         venue requirements; adding provisions relating to the
  798         payment of fines; amending s. 409.920, F.S.;
  799         clarifying provisions relating to immunity from
  800         liability for persons who provide information about
  801         Medicaid fraud; amending s. 624.351, F.S.; providing
  802         for the expiration of the Medicaid and Public
  803         Assistance Fraud Strike Force; amending s. 624.352,
  804         F.S.; providing for the expiration of provisions
  805         relating to “Strike Force” agreements; providing an
  806         effective date.