Florida Senate - 2013                                     SB 844
       
       
       
       By Senator Grimsley
       
       
       
       
       21-01001-13                                            2013844__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid fraud; amending s.
    3         409.907, F.S.; increasing the number of years a
    4         provider must keep records; adding an additional
    5         provision relating to a change in principal that must
    6         be included in a Medicaid provider agreement with the
    7         Agency for Health Care Administration; adding
    8         definitions for “administrative fines” and
    9         “outstanding overpayment”; revising provisions
   10         relating to the agency’s onsite inspection
   11         responsibilities; revising provisions relating to who
   12         is subject to background screening; amending s.
   13         409.91212, F.S.; requiring the agency to enter into an
   14         interagency agreement with the Division of Insurance
   15         Fraud regarding anti-fraud plans by managed care
   16         plans; delaying the imposition of certain fines for
   17         failing to report; amending s. 409.913, F.S.;
   18         authorizing the agency to review and analyze sources
   19         other than providers in order to carry out its duties
   20         with respect to its Medicaid oversight
   21         responsibilities; increasing the number of years a
   22         provider must keep records; revising provisions
   23         specifying grounds for terminating a provider from the
   24         program, for seeking certain remedies for violations,
   25         and for imposing certain sanctions; providing a
   26         limitation on the information the agency may consider
   27         when making a determination of overpayment; specifying
   28         the type of records a provider must present to contest
   29         an overpayment; deleting the requirement that the
   30         agency pay interest on certain payments withheld from
   31         a provider and revising when a provider must reimburse
   32         overpayments; revising venue requirements; adding
   33         provisions relating to the payment of fines; amending
   34         s. 409.920, F.S.; clarifying provisions relating to
   35         immunity from liability for persons who provide
   36         information about Medicaid fraud; providing an
   37         effective date.
   38  
   39  Be It Enacted by the Legislature of the State of Florida:
   40  
   41         Section 1. Paragraph (c) of subsection (3) of section
   42  409.907, Florida Statutes, is amended and paragraph (k) is added
   43  to that subsection, and subsections (6), (7), and (8) of that
   44  section are amended to read:
   45         409.907 Medicaid provider agreements.—The agency may make
   46  payments for medical assistance and related services rendered to
   47  Medicaid recipients only to an individual or entity who has a
   48  provider agreement in effect with the agency, who is performing
   49  services or supplying goods in accordance with federal, state,
   50  and local law, and who agrees that no person shall, on the
   51  grounds of handicap, race, color, or national origin, or for any
   52  other reason, be subjected to discrimination under any program
   53  or activity for which the provider receives payment from the
   54  agency.
   55         (3) The provider agreement developed by the agency, in
   56  addition to the requirements specified in subsections (1) and
   57  (2), shall require the provider to:
   58         (c) Retain all medical and Medicaid-related records for 6 a
   59  period of 5 years to satisfy all necessary inquiries by the
   60  agency.
   61         (k) Report a change in any principal of the provider,
   62  including any officer, director, agent, managing employee, or
   63  affiliated person, or any partner or shareholder who has an
   64  ownership interest equal to 5 percent or more in the provider,
   65  to the agency in writing within 30 days after the change occurs.
   66  For a hospital licensed under chapter 395 or a nursing home
   67  licensed under part II of chapter 400, a principal of the
   68  provider is one who meets the definition of a controlling
   69  interest under s. 408.803.
   70         (6) A Medicaid provider agreement may be revoked, at the
   71  option of the agency, due to as the result of a change of
   72  ownership of any facility, association, partnership, or other
   73  entity named as the provider in the provider agreement.
   74         (a) If there is In the event of a change of ownership, the
   75  transferor remains liable for all outstanding overpayments,
   76  administrative fines, and any other moneys owed to the agency
   77  before the effective date of the change of ownership. In
   78  addition to the continuing liability of the transferor, The
   79  transferee is also liable to the agency for all outstanding
   80  overpayments identified by the agency on or before the effective
   81  date of the change of ownership. For purposes of this
   82  subsection, the term “outstanding overpayment” includes any
   83  amount identified in a preliminary audit report issued to the
   84  transferor by the agency on or before the effective date of the
   85  change of ownership. In the event of a change of ownership for a
   86  skilled nursing facility or intermediate care facility, the
   87  Medicaid provider agreement shall be assigned to the transferee
   88  if the transferee meets all other Medicaid provider
   89  qualifications. In the event of a change of ownership involving
   90  a skilled nursing facility licensed under part II of chapter
   91  400, liability for all outstanding overpayments, administrative
   92  fines, and any moneys owed to the agency before the effective
   93  date of the change of ownership shall be determined in
   94  accordance with s. 400.179.
   95         (b) At least 60 days before the anticipated date of the
   96  change of ownership, the transferor must shall notify the agency
   97  of the intended change of ownership and the transferee must
   98  shall submit to the agency a Medicaid provider enrollment
   99  application. If a change of ownership occurs without compliance
  100  with the notice requirements of this subsection, the transferor
  101  and transferee are shall be jointly and severally liable for all
  102  overpayments, administrative fines, and other moneys due to the
  103  agency, regardless of whether the agency identified the
  104  overpayments, administrative fines, or other moneys before or
  105  after the effective date of the change of ownership. The agency
  106  may not approve a transferee’s Medicaid provider enrollment
  107  application if the transferee or transferor has not paid or
  108  agreed in writing to a payment plan for all outstanding
  109  overpayments, administrative fines, and other moneys due to the
  110  agency. This subsection does not preclude the agency from
  111  seeking any other legal or equitable remedies available to the
  112  agency for the recovery of moneys owed to the Medicaid program.
  113  In the event of a change of ownership involving a skilled
  114  nursing facility licensed under part II of chapter 400,
  115  liability for all outstanding overpayments, administrative
  116  fines, and any moneys owed to the agency before the effective
  117  date of the change of ownership shall be determined in
  118  accordance with s. 400.179 if the Medicaid provider enrollment
  119  application for change of ownership is submitted before the
  120  change of ownership.
  121         (c) As used in this subsection, the term:
  122         1.“Administrative fines” includes any amount identified in
  123  a notice of a monetary penalty or fine which has been issued by
  124  the agency or other regulatory or licensing agency that governs
  125  the provider.
  126         2.“Outstanding overpayment” includes any amount identified
  127  in a preliminary audit report issued to the transferor by the
  128  agency on or before the effective date of a change of ownership.
  129         (7) The agency may require, As a condition of participating
  130  in the Medicaid program and before entering into the provider
  131  agreement, the agency may require that the provider to submit
  132  information, in an initial and any required renewal
  133  applications, concerning the professional, business, and
  134  personal background of the provider and permit an onsite
  135  inspection of the provider’s service location by agency staff or
  136  other personnel designated by the agency to perform this
  137  function. Before entering into a provider agreement, the agency
  138  may shall perform an a random onsite inspection, within 60 days
  139  after receipt of a fully complete new provider’s application, of
  140  the provider’s service location prior to making its first
  141  payment to the provider for Medicaid services to determine the
  142  applicant’s ability to provide the services in compliance with
  143  the Medicaid program and professional regulations that the
  144  applicant is proposing to provide for Medicaid reimbursement.
  145  The agency is not required to perform an onsite inspection of a
  146  provider or program that is licensed by the agency, that
  147  provides services under waiver programs for home and community
  148  based services, or that is licensed as a medical foster home by
  149  the Department of Children and Family Services. As a continuing
  150  condition of participation in the Medicaid program, a provider
  151  must shall immediately notify the agency of any current or
  152  pending bankruptcy filing. Before entering into the provider
  153  agreement, or as a condition of continuing participation in the
  154  Medicaid program, the agency may also require that Medicaid
  155  providers reimbursed on a fee-for-services basis or fee schedule
  156  basis that which is not cost-based, post a surety bond not to
  157  exceed $50,000 or the total amount billed by the provider to the
  158  program during the current or most recent calendar year,
  159  whichever is greater. For new providers, the amount of the
  160  surety bond shall be determined by the agency based on the
  161  provider’s estimate of its first year’s billing. If the
  162  provider’s billing during the first year exceeds the bond
  163  amount, the agency may require the provider to acquire an
  164  additional bond equal to the actual billing level of the
  165  provider. A provider’s bond need shall not exceed $50,000 if a
  166  physician or group of physicians licensed under chapter 458,
  167  chapter 459, or chapter 460 has a 50 percent or greater
  168  ownership interest in the provider or if the provider is an
  169  assisted living facility licensed under chapter 429. The bonds
  170  permitted by this section are in addition to the bonds
  171  referenced in s. 400.179(2)(d). If the provider is a
  172  corporation, partnership, association, or other entity, the
  173  agency may require the provider to submit information concerning
  174  the background of that entity and of any principal of the
  175  entity, including any partner or shareholder having an ownership
  176  interest in the entity equal to 5 percent or greater, and any
  177  treating provider who participates in or intends to participate
  178  in Medicaid through the entity. The information must include:
  179         (a) Proof of holding a valid license or operating
  180  certificate, as applicable, if required by the state or local
  181  jurisdiction in which the provider is located or if required by
  182  the Federal Government.
  183         (b) Information concerning any prior violation, fine,
  184  suspension, termination, or other administrative action taken
  185  under the Medicaid laws or, rules, or regulations of this state
  186  or of any other state or the Federal Government; any prior
  187  violation of the laws or, rules, or regulations relating to the
  188  Medicare program; any prior violation of the rules or
  189  regulations of any other public or private insurer; and any
  190  prior violation of the laws or, rules, or regulations of any
  191  regulatory body of this or any other state.
  192         (c) Full and accurate disclosure of any financial or
  193  ownership interest that the provider, or any principal, partner,
  194  or major shareholder thereof, may hold in any other Medicaid
  195  provider or health care related entity or any other entity that
  196  is licensed by the state to provide health or residential care
  197  and treatment to persons.
  198         (d) If a group provider, identification of all members of
  199  the group and attestation that all members of the group are
  200  enrolled in or have applied to enroll in the Medicaid program.
  201         (8)(a) Each provider, or each principal of the provider if
  202  the provider is a corporation, partnership, association, or
  203  other entity, seeking to participate in the Medicaid program,
  204  including Medicaid managed care network providers, must submit a
  205  complete set of his or her fingerprints to the agency for the
  206  purpose of conducting a criminal history record check.
  207  Principals of the provider include any officer, director,
  208  billing agent, managing employee, or affiliated person, or any
  209  partner or shareholder who has an ownership interest equal to 5
  210  percent or more in the provider. However, for a hospital
  211  licensed under chapter 395 or a nursing home licensed under
  212  chapter 400, principals of the provider are those who meet the
  213  definition of a controlling interest under s. 408.803. A
  214  director of a not-for-profit corporation or organization is not
  215  a principal for purposes of a background investigation as
  216  required by this section if the director: serves solely in a
  217  voluntary capacity for the corporation or organization, does not
  218  regularly take part in the day-to-day operational decisions of
  219  the corporation or organization, receives no remuneration from
  220  the not-for-profit corporation or organization for his or her
  221  service on the board of directors, has no financial interest in
  222  the not-for-profit corporation or organization, and has no
  223  family members with a financial interest in the not-for-profit
  224  corporation or organization; and if the director submits an
  225  affidavit, under penalty of perjury, to this effect to the
  226  agency and the not-for-profit corporation or organization
  227  submits an affidavit, under penalty of perjury, to this effect
  228  to the agency as part of the corporation’s or organization’s
  229  Medicaid provider agreement application. Notwithstanding the
  230  above, the agency may require a background check for any person
  231  reasonably suspected by the agency to have been convicted of a
  232  crime.
  233         (a) This subsection does not apply to:
  234         1. A hospital licensed under chapter 395;
  235         2. A nursing home licensed under chapter 400;
  236         3. A hospice licensed under chapter 400;
  237         4. An assisted living facility licensed under chapter 429;
  238         1.5. A unit of local government, except that requirements
  239  of this subsection apply to nongovernmental providers and
  240  entities contracting with the local government to provide
  241  Medicaid services. The actual cost of the state and national
  242  criminal history record checks must be borne by the
  243  nongovernmental provider or entity; or
  244         2.6. Any business that derives more than 50 percent of its
  245  revenue from the sale of goods to the final consumer, and the
  246  business or its controlling parent is required to file a form
  247  10-K or other similar statement with the Securities and Exchange
  248  Commission or has a net worth of $50 million or more.
  249         (b) Background screening shall be conducted in accordance
  250  with chapter 435 and s. 408.809. The cost of the state and
  251  national criminal record check shall be borne by the provider.
  252         (c) Proof of compliance with the requirements of level 2
  253  screening under chapter 435 conducted within 12 months before
  254  the date the Medicaid provider application is submitted to the
  255  agency fulfills the requirements of this subsection.
  256         Section 2. Subsections (1) and (6) of section 409.91212,
  257  Florida Statutes, are amended to read:
  258         409.91212 Medicaid managed care fraud.—
  259         (1) Each managed care plan, as defined in s. 409.920(1)(e),
  260  shall adopt an anti-fraud plan addressing the detection and
  261  prevention of overpayments, abuse, and fraud relating to the
  262  provision of and payment for Medicaid services and submit the
  263  plan to the Office of Medicaid Program Integrity within the
  264  agency for approval. The office shall enter into an interagency
  265  agreement with the Division of Insurance Fraud in the Department
  266  of Financial Services which delineates the responsibilities of
  267  the agency in reviewing and approving anti-fraud plans for
  268  entities that are also required to submit anti-fraud plans under
  269  s. 626.9891. At a minimum, the anti-fraud plan must include:
  270         (a) A written description or chart outlining the
  271  organizational arrangement of the plan’s personnel who are
  272  responsible for the investigation and reporting of possible
  273  overpayment, abuse, or fraud;
  274         (b) A description of the plan’s procedures for detecting
  275  and investigating possible acts of fraud, abuse, and
  276  overpayment;
  277         (c) A description of the plan’s procedures for the
  278  mandatory reporting of possible overpayment, abuse, or fraud to
  279  the Office of Medicaid Program Integrity within the agency;
  280         (d) A description of the plan’s program and procedures for
  281  educating and training personnel on how to detect and prevent
  282  fraud, abuse, and overpayment;
  283         (e) The name, address, telephone number, e-mail address,
  284  and fax number of the individual responsible for carrying out
  285  the anti-fraud plan; and
  286         (f) A summary of the results of the investigations of
  287  fraud, abuse, or overpayment which were conducted during the
  288  previous year by the managed care organization’s fraud
  289  investigative unit.
  290         (6) Each managed care plan shall report all suspected or
  291  confirmed instances of provider or recipient fraud or abuse
  292  within 15 calendar days after detection to the Office of
  293  Medicaid Program Integrity within the agency. At a minimum the
  294  report must contain the name of the provider or recipient, the
  295  Medicaid billing number or tax identification number, and a
  296  description of the fraudulent or abusive act. The office of
  297  Medicaid Program Integrity in the agency shall forward the
  298  report of suspected overpayment, abuse, or fraud to the
  299  appropriate investigative unit, including, but not limited to,
  300  the Bureau of Medicaid program integrity, the Medicaid fraud
  301  control unit, the Division of Public Assistance Fraud, the
  302  Division of Insurance Fraud, or the Department of Law
  303  Enforcement.
  304         (a) Failure to timely report shall result in an
  305  administrative fine of $1,000 per calendar day after the 60th
  306  15th day of detection.
  307         (b) Failure to timely report may result in additional
  308  administrative, civil, or criminal penalties.
  309         Section 3. Subsections (2), (9), (13), (15), (16), (21),
  310  (22), (25), (28), (29), (30) and (31) of section 409.913,
  311  Florida Statutes, are amended to read:
  312         409.913 Oversight of the integrity of the Medicaid
  313  program.—The agency shall operate a program to oversee the
  314  activities of Florida Medicaid recipients, and providers and
  315  their representatives, to ensure that fraudulent and abusive
  316  behavior and neglect of recipients occur to the minimum extent
  317  possible, and to recover overpayments and impose sanctions as
  318  appropriate. Beginning January 1, 2003, and each year
  319  thereafter, the agency and the Medicaid Fraud Control Unit of
  320  the Department of Legal Affairs shall submit a joint report to
  321  the Legislature documenting the effectiveness of the state’s
  322  efforts to control Medicaid fraud and abuse and to recover
  323  Medicaid overpayments during the previous fiscal year. The
  324  report must describe the number of cases opened and investigated
  325  each year; the sources of the cases opened; the disposition of
  326  the cases closed each year; the amount of overpayments alleged
  327  in preliminary and final audit letters; the number and amount of
  328  fines or penalties imposed; any reductions in overpayment
  329  amounts negotiated in settlement agreements or by other means;
  330  the amount of final agency determinations of overpayments; the
  331  amount deducted from federal claiming as a result of
  332  overpayments; the amount of overpayments recovered each year;
  333  the amount of cost of investigation recovered each year; the
  334  average length of time to collect from the time the case was
  335  opened until the overpayment is paid in full; the amount
  336  determined as uncollectible and the portion of the uncollectible
  337  amount subsequently reclaimed from the Federal Government; the
  338  number of providers, by type, that are terminated from
  339  participation in the Medicaid program as a result of fraud and
  340  abuse; and all costs associated with discovering and prosecuting
  341  cases of Medicaid overpayments and making recoveries in such
  342  cases. The report must also document actions taken to prevent
  343  overpayments and the number of providers prevented from
  344  enrolling in or reenrolling in the Medicaid program as a result
  345  of documented Medicaid fraud and abuse and must include policy
  346  recommendations necessary to prevent or recover overpayments and
  347  changes necessary to prevent and detect Medicaid fraud. All
  348  policy recommendations in the report must include a detailed
  349  fiscal analysis, including, but not limited to, implementation
  350  costs, estimated savings to the Medicaid program, and the return
  351  on investment. The agency must submit the policy recommendations
  352  and fiscal analyses in the report to the appropriate estimating
  353  conference, pursuant to s. 216.137, by February 15 of each year.
  354  The agency and the Medicaid Fraud Control Unit of the Department
  355  of Legal Affairs each must include detailed unit-specific
  356  performance standards, benchmarks, and metrics in the report,
  357  including projected cost savings to the state Medicaid program
  358  during the following fiscal year.
  359         (2) The agency shall conduct, or cause to be conducted by
  360  contract or otherwise, reviews, investigations, analyses,
  361  audits, or any combination thereof, to determine possible fraud,
  362  abuse, overpayment, or recipient neglect in the Medicaid program
  363  and shall report the findings of any overpayments in audit
  364  reports as appropriate. At least 5 percent of all audits must
  365  shall be conducted on a random basis. As part of its ongoing
  366  fraud detection activities, the agency shall identify and
  367  monitor, by contract or otherwise, patterns of overutilization
  368  of Medicaid services based on state averages. The agency shall
  369  track Medicaid provider prescription and billing patterns and
  370  evaluate them against Medicaid medical necessity criteria and
  371  coverage and limitation guidelines adopted by rule. Medical
  372  necessity determination requires that service be consistent with
  373  symptoms or confirmed diagnosis of illness or injury under
  374  treatment and not in excess of the patient’s needs. The agency
  375  shall conduct reviews of provider exceptions to peer group norms
  376  and shall, using statistical methodologies, provider profiling,
  377  and analysis of billing patterns, shall detect and investigate
  378  abnormal or unusual increases in billing or payment of claims
  379  for Medicaid services and medically unnecessary provision of
  380  services. The agency may review and analyze information from
  381  sources other than enrolled Medicaid providers in conducting its
  382  activities under this subsection.
  383         (9) A Medicaid provider shall retain medical, professional,
  384  financial, and business records pertaining to services and goods
  385  furnished to a Medicaid recipient and billed to Medicaid for 6 a
  386  period of 5 years after the date of furnishing such services or
  387  goods. The agency may investigate, review, or analyze such
  388  records, which must be made available during normal business
  389  hours. However, 24-hour notice must be provided if patient
  390  treatment would be disrupted. The provider must keep is
  391  responsible for furnishing to the agency, and keeping the agency
  392  informed of the location of, the provider’s Medicaid-related
  393  records. The authority of the agency to obtain Medicaid-related
  394  records from a provider is neither curtailed nor limited during
  395  a period of litigation between the agency and the provider.
  396         (13) The agency shall immediately terminate participation
  397  of a Medicaid provider in the Medicaid program and may seek
  398  civil remedies or impose other administrative sanctions against
  399  a Medicaid provider, if the provider or any principal, officer,
  400  director, agent, managing employee, or affiliated person of the
  401  provider, or any partner or shareholder having an ownership
  402  interest in the provider equal to 5 percent or greater, has been
  403  convicted of a criminal offense under federal law or the law of
  404  any state relating to the practice of the provider’s profession,
  405  or a criminal offense listed under s. 409.907(10), s.
  406  408.809(4), or s. 435.04(2) has been:
  407         (a) Convicted of a criminal offense related to the delivery
  408  of any health care goods or services, including the performance
  409  of management or administrative functions relating to the
  410  delivery of health care goods or services;
  411         (b) Convicted of a criminal offense under federal law or
  412  the law of any state relating to the practice of the provider’s
  413  profession; or
  414         (c) Found by a court of competent jurisdiction to have
  415  neglected or physically abused a patient in connection with the
  416  delivery of health care goods or services. If the agency
  417  determines that the a provider did not participate or acquiesce
  418  in the an offense specified in paragraph (a), paragraph (b), or
  419  paragraph (c), termination will not be imposed. If the agency
  420  effects a termination under this subsection, the agency shall
  421  take final action issue an immediate final order pursuant to s.
  422  120.569(2)(n).
  423         (15) The agency shall seek a remedy provided by law,
  424  including, but not limited to, any remedy provided in
  425  subsections (13) and (16) and s. 812.035, if:
  426         (a) The provider’s license has not been renewed, or has
  427  been revoked, suspended, or terminated, for cause, by the
  428  licensing agency of any state;
  429         (b) The provider has failed to make available or has
  430  refused access to Medicaid-related records to an auditor,
  431  investigator, or other authorized employee or agent of the
  432  agency, the Attorney General, a state attorney, or the Federal
  433  Government;
  434         (c) The provider has not furnished or has failed to make
  435  available such Medicaid-related records as the agency has found
  436  necessary to determine whether Medicaid payments are or were due
  437  and the amounts thereof;
  438         (d) The provider has failed to maintain medical records
  439  made at the time of service, or prior to service if prior
  440  authorization is required, demonstrating the necessity and
  441  appropriateness of the goods or services rendered;
  442         (e) The provider is not in compliance with provisions of
  443  Medicaid provider publications that have been adopted by
  444  reference as rules in the Florida Administrative Code; with
  445  provisions of state or federal laws, rules, or regulations; with
  446  provisions of the provider agreement between the agency and the
  447  provider; or with certifications found on claim forms or on
  448  transmittal forms for electronically submitted claims that are
  449  submitted by the provider or authorized representative, as such
  450  provisions apply to the Medicaid program;
  451         (f) The provider or person who ordered, authorized, or
  452  prescribed the care, services, or supplies has furnished, or
  453  ordered or authorized the furnishing of, goods or services to a
  454  recipient which are inappropriate, unnecessary, excessive, or
  455  harmful to the recipient or are of inferior quality;
  456         (g) The provider has demonstrated a pattern of failure to
  457  provide goods or services that are medically necessary;
  458         (h) The provider or an authorized representative of the
  459  provider, or a person who ordered, authorized, or prescribed the
  460  goods or services, has submitted or caused to be submitted false
  461  or a pattern of erroneous Medicaid claims;
  462         (i) The provider or an authorized representative of the
  463  provider, or a person who has ordered, authorized, or prescribed
  464  the goods or services, has submitted or caused to be submitted a
  465  Medicaid provider enrollment application, a request for prior
  466  authorization for Medicaid services, a drug exception request,
  467  or a Medicaid cost report that contains materially false or
  468  incorrect information;
  469         (j) The provider or an authorized representative of the
  470  provider has collected from or billed a recipient or a
  471  recipient’s responsible party improperly for amounts that should
  472  not have been so collected or billed by reason of the provider’s
  473  billing the Medicaid program for the same service;
  474         (k) The provider or an authorized representative of the
  475  provider has included in a cost report costs that are not
  476  allowable under a Florida Title XIX reimbursement plan, after
  477  the provider or authorized representative had been advised in an
  478  audit exit conference or audit report that the costs were not
  479  allowable;
  480         (l) The provider is charged by information or indictment
  481  with fraudulent billing practices or an offense referenced in
  482  subsection (13). The sanction applied for this reason is limited
  483  to suspension of the provider’s participation in the Medicaid
  484  program for the duration of the indictment unless the provider
  485  is found guilty pursuant to the information or indictment;
  486         (m) The provider or a person who has ordered, authorized,
  487  or prescribed the goods or services is found liable for
  488  negligent practice resulting in death or injury to the
  489  provider’s patient;
  490         (n) The provider fails to demonstrate that it had available
  491  during a specific audit or review period sufficient quantities
  492  of goods, or sufficient time in the case of services, to support
  493  the provider’s billings to the Medicaid program;
  494         (o) The provider has failed to comply with the notice and
  495  reporting requirements of s. 409.907;
  496         (p) The agency has received reliable information of patient
  497  abuse or neglect or of any act prohibited by s. 409.920; or
  498         (q) The provider has failed to comply with an agreed-upon
  499  repayment schedule.
  500  
  501  A provider is subject to sanctions for violations of this
  502  subsection as the result of actions or inactions of the
  503  provider, or actions or inactions of any principal, officer,
  504  director, agent, managing employee, or affiliated person of the
  505  provider, or any partner or shareholder having an ownership
  506  interest in the provider equal to 5 percent or greater, in which
  507  the provider participated or acquiesced.
  508         (16) The agency shall impose any of the following sanctions
  509  or disincentives on a provider or a person for any of the acts
  510  described in subsection (15):
  511         (a) Suspension for a specific period of time of not more
  512  than 1 year. Suspension precludes shall preclude participation
  513  in the Medicaid program, which includes any action that results
  514  in a claim for payment to the Medicaid program for as a result
  515  of furnishing, supervising a person who is furnishing, or
  516  causing a person to furnish goods or services.
  517         (b) Termination for a specific period of time ranging of
  518  from more than 1 year to 20 years. Termination precludes shall
  519  preclude participation in the Medicaid program, which includes
  520  any action that results in a claim for payment to the Medicaid
  521  program for as a result of furnishing, supervising a person who
  522  is furnishing, or causing a person to furnish goods or services.
  523         (c) Imposition of a fine of up to $5,000 for each
  524  violation. Each day that an ongoing violation continues, such as
  525  refusing to furnish Medicaid-related records or refusing access
  526  to records, is considered, for the purposes of this section, to
  527  be a separate violation. Each instance of improper billing of a
  528  Medicaid recipient; each instance of including an unallowable
  529  cost on a hospital or nursing home Medicaid cost report after
  530  the provider or authorized representative has been advised in an
  531  audit exit conference or previous audit report of the cost
  532  unallowability; each instance of furnishing a Medicaid recipient
  533  goods or professional services that are inappropriate or of
  534  inferior quality as determined by competent peer judgment; each
  535  instance of knowingly submitting a materially false or erroneous
  536  Medicaid provider enrollment application, request for prior
  537  authorization for Medicaid services, drug exception request, or
  538  cost report; each instance of inappropriate prescribing of drugs
  539  for a Medicaid recipient as determined by competent peer
  540  judgment; and each false or erroneous Medicaid claim leading to
  541  an overpayment to a provider is considered, for the purposes of
  542  this section, to be a separate violation.
  543         (d) Immediate suspension, if the agency has received
  544  information of patient abuse or neglect or of any act prohibited
  545  by s. 409.920. Upon suspension, the agency must issue an
  546  immediate final order under s. 120.569(2)(n).
  547         (e) A fine, not to exceed $10,000, for a violation of
  548  paragraph (15)(i).
  549         (f) Imposition of liens against provider assets, including,
  550  but not limited to, financial assets and real property, not to
  551  exceed the amount of fines or recoveries sought, upon entry of
  552  an order determining that such moneys are due or recoverable.
  553         (g) Prepayment reviews of claims for a specified period of
  554  time.
  555         (h) Comprehensive followup reviews of providers every 6
  556  months to ensure that they are billing Medicaid correctly.
  557         (i) Corrective-action plans that would remain in effect for
  558  providers for up to 3 years and that are would be monitored by
  559  the agency every 6 months while in effect.
  560         (j) Other remedies as permitted by law to effect the
  561  recovery of a fine or overpayment.
  562  
  563  If a provider voluntarily relinquishes its Medicaid provider
  564  number or an associated license, or allows the associated
  565  licensure to expire after receiving written notice that the
  566  agency is conducting, or has conducted, an audit, survey,
  567  inspection, or investigation and that a sanction of suspension
  568  or termination will or would be imposed for noncompliance
  569  discovered as a result of the audit, survey, inspection, or
  570  investigation, the agency shall impose the sanction of
  571  termination for cause against the provider. The Secretary of
  572  Health Care Administration may make a determination that
  573  imposition of a sanction or disincentive is not in the best
  574  interest of the Medicaid program, in which case a sanction or
  575  disincentive may shall not be imposed.
  576         (21) When making a determination that an overpayment has
  577  occurred, the agency shall prepare and issue an audit report to
  578  the provider showing the calculation of overpayments. The
  579  agency’s determination must be based solely upon information
  580  available to it before issuance of the audit report and, in the
  581  case of documentation obtained to substantiate claims for
  582  Medicaid reimbursement, based solely upon contemporaneous
  583  records.
  584         (22) The audit report, supported by agency work papers,
  585  showing an overpayment to a provider constitutes evidence of the
  586  overpayment. A provider may not present or elicit testimony,
  587  either on direct examination or cross-examination in any court
  588  or administrative proceeding, regarding the purchase or
  589  acquisition by any means of drugs, goods, or supplies; sales or
  590  divestment by any means of drugs, goods, or supplies; or
  591  inventory of drugs, goods, or supplies, unless such acquisition,
  592  sales, divestment, or inventory is documented by written
  593  invoices, written inventory records, or other competent written
  594  documentary evidence maintained in the normal course of the
  595  provider’s business. A provider may not present records to
  596  contest an overpayment or sanction unless such records are
  597  contemporaneous and, if requested during the audit process, were
  598  furnished to the agency or its agent upon request or were
  599  furnished within 30 days after the provider received the final
  600  audit report. This limitation does not apply to Medicaid cost
  601  report audits. Notwithstanding the applicable rules of
  602  discovery, all documentation to that will be offered as evidence
  603  at an administrative hearing on a Medicaid overpayment or an
  604  administrative sanction must be exchanged by all parties at
  605  least 14 days before the administrative hearing or must be
  606  excluded from consideration.
  607         (25)(a) The agency shall withhold Medicaid payments, in
  608  whole or in part, to a provider upon receipt of reliable
  609  evidence that the circumstances giving rise to the need for a
  610  withholding of payments involve fraud, willful
  611  misrepresentation, or abuse under the Medicaid program, or a
  612  crime committed while rendering goods or services to Medicaid
  613  recipients. If it is determined that fraud, willful
  614  misrepresentation, abuse, or a crime did not occur, the payments
  615  withheld must be paid to the provider within 14 days after such
  616  determination with interest at the rate of 10 percent a year.
  617  Any money withheld in accordance with this paragraph shall be
  618  placed in a suspended account, readily accessible to the agency,
  619  so that any payment ultimately due the provider shall be made
  620  within 14 days.
  621         (b) The agency shall deny payment, or require repayment, if
  622  the goods or services were furnished, supervised, or caused to
  623  be furnished by a person who has been suspended or terminated
  624  from the Medicaid program or Medicare program by the Federal
  625  Government or any state.
  626         (c) Overpayments owed to the agency bear interest at the
  627  rate of 10 percent per year from the date of determination of
  628  the overpayment by the agency, and payment arrangements must be
  629  made within 30 days after the date of the final order and are
  630  not subject to further appeal at the conclusion of legal
  631  proceedings. A provider who does not enter into or adhere to an
  632  agreed-upon repayment schedule may be terminated by the agency
  633  for nonpayment or partial payment.
  634         (d) The agency, upon entry of a final agency order, a
  635  judgment or order of a court of competent jurisdiction, or a
  636  stipulation or settlement, may collect the moneys owed by all
  637  means allowable by law, including, but not limited to, notifying
  638  any fiscal intermediary of Medicare benefits that the state has
  639  a superior right of payment. Upon receipt of such written
  640  notification, the Medicare fiscal intermediary shall remit to
  641  the state the sum claimed.
  642         (e) The agency may institute amnesty programs to allow
  643  Medicaid providers the opportunity to voluntarily repay
  644  overpayments. The agency may adopt rules to administer such
  645  programs.
  646         (28) Venue for all Medicaid program integrity overpayment
  647  cases lies shall lie in Leon County, at the discretion of the
  648  agency.
  649         (29) Notwithstanding other provisions of law, the agency
  650  and the Medicaid Fraud Control Unit of the Department of Legal
  651  Affairs may review a person’s or provider’s Medicaid-related and
  652  non-Medicaid-related records in order to determine the total
  653  output of a provider’s practice to reconcile quantities of goods
  654  or services billed to Medicaid with quantities of goods or
  655  services used in the provider’s total practice.
  656         (30) The agency shall terminate a provider’s participation
  657  in the Medicaid program if the provider fails to reimburse an
  658  overpayment or pay an agency-imposed fine that has been
  659  determined by final order, not subject to further appeal, within
  660  30 35 days after the date of the final order, unless the
  661  provider and the agency have entered into a repayment agreement.
  662         (31) If a provider requests an administrative hearing
  663  pursuant to chapter 120, such hearing must be conducted within
  664  90 days following assignment of an administrative law judge,
  665  absent exceptionally good cause shown as determined by the
  666  administrative law judge or hearing officer. Upon issuance of a
  667  final order, the outstanding balance of the amount determined to
  668  constitute the overpayment and fines is shall become due. If a
  669  provider fails to make payments in full, fails to enter into a
  670  satisfactory repayment plan, or fails to comply with the terms
  671  of a repayment plan or settlement agreement, the agency shall
  672  withhold medical assistance reimbursement payments for Medicaid
  673  services until the amount due is paid in full.
  674         Section 4. Subsection (8) of section 409.920, Florida
  675  Statutes, is amended to read:
  676         409.920 Medicaid provider fraud.—
  677         (8) A person who provides the state, any state agency, any
  678  of the state’s political subdivisions, or any agency of the
  679  state’s political subdivisions with information about fraud or
  680  suspected fraudulent acts fraud by a Medicaid provider,
  681  including a managed care organization, is immune from civil
  682  liability for libel, slander, or any other relevant tort for
  683  providing the information about fraud or suspected fraudulent
  684  acts, unless the person acted with knowledge that the
  685  information was false or with reckless disregard for the truth
  686  or falsity of the information. Such immunity extends to reports
  687  of fraudulent acts or suspected fraudulent acts conveyed to or
  688  from the agency in any manner, including any forum and with any
  689  audience as directed by the agency, and includes all discussions
  690  subsequent to the report and subsequent inquiries from the
  691  agency, unless the person acted with knowledge that the
  692  information was false or with reckless disregard for the truth
  693  or falsity of the information. For purposes of this subsection,
  694  the term “fraudulent acts” includes actual or suspected fraud
  695  and abuse, insurance fraud, licensure fraud, or public
  696  assistance fraud, including any fraud-related matters that a
  697  provider or health plan is required to report to the agency or a
  698  law enforcement agency.
  699         Section 5. This act shall take effect July 1, 2013.