Florida Senate - 2013                              CS for SB 844
       
       
       
       By the Committee on Health Policy; and Senator Grimsley
       
       
       
       
       588-02020-13                                           2013844c1
    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         409.913, F.S.; increasing the number of years a
   14         provider must keep records; revising provisions
   15         specifying grounds for terminating a provider from the
   16         program, for seeking certain remedies for violations,
   17         and for imposing certain sanctions; providing a
   18         limitation on the information the agency may consider
   19         when making a determination of overpayment; specifying
   20         the type of records a provider must present to contest
   21         an overpayment; deleting the requirement that the
   22         agency place payments withheld from a provider in a
   23         suspended account and revising when a provider must
   24         reimburse overpayments; revising venue requirements;
   25         adding provisions relating to the payment of fines;
   26         amending s. 409.920, F.S.; clarifying provisions
   27         relating to immunity from liability for persons who
   28         provide information about Medicaid fraud; providing an
   29         effective date.
   30  
   31  Be It Enacted by the Legislature of the State of Florida:
   32  
   33         Section 1. Paragraph (c) of subsection (3) of section
   34  409.907, Florida Statutes, is amended and paragraph (k) is added
   35  to that subsection, and subsections (6), (7), and (8) of that
   36  section are amended to read:
   37         409.907 Medicaid provider agreements.—The agency may make
   38  payments for medical assistance and related services rendered to
   39  Medicaid recipients only to an individual or entity who has a
   40  provider agreement in effect with the agency, who is performing
   41  services or supplying goods in accordance with federal, state,
   42  and local law, and who agrees that no person shall, on the
   43  grounds of handicap, race, color, or national origin, or for any
   44  other reason, be subjected to discrimination under any program
   45  or activity for which the provider receives payment from the
   46  agency.
   47         (3) The provider agreement developed by the agency, in
   48  addition to the requirements specified in subsections (1) and
   49  (2), shall require the provider to:
   50         (c) Retain all medical and Medicaid-related records for 6 a
   51  period of 5 years to satisfy all necessary inquiries by the
   52  agency.
   53         (k) Report a change in any principal of the provider,
   54  including any officer, director, agent, managing employee, or
   55  affiliated person, or any partner or shareholder who has an
   56  ownership interest equal to 5 percent or more in the provider,
   57  to the agency in writing within 30 days after the change occurs.
   58  For a hospital licensed under chapter 395 or a nursing home
   59  licensed under part II of chapter 400, a principal of the
   60  provider is one who meets the definition of a controlling
   61  interest under s. 408.803.
   62         (6) A Medicaid provider agreement may be revoked, at the
   63  option of the agency, due to as the result of a change of
   64  ownership of any facility, association, partnership, or other
   65  entity named as the provider in the provider agreement.
   66         (a) If there is In the event of a change of ownership, the
   67  transferor remains liable for all outstanding overpayments,
   68  administrative fines, and any other moneys owed to the agency
   69  before the effective date of the change of ownership. In
   70  addition to the continuing liability of the transferor, The
   71  transferee is also liable to the agency for all outstanding
   72  overpayments identified by the agency on or before the effective
   73  date of the change of ownership. For purposes of this
   74  subsection, the term “outstanding overpayment” includes any
   75  amount identified in a preliminary audit report issued to the
   76  transferor by the agency on or before the effective date of the
   77  change of ownership. In the event of a change of ownership for a
   78  skilled nursing facility or intermediate care facility, the
   79  Medicaid provider agreement shall be assigned to the transferee
   80  if the transferee meets all other Medicaid provider
   81  qualifications. In the event of a change of ownership involving
   82  a skilled nursing facility licensed under part II of chapter
   83  400, liability for all outstanding overpayments, administrative
   84  fines, and any moneys owed to the agency before the effective
   85  date of the change of ownership shall be determined in
   86  accordance with s. 400.179.
   87         (b) At least 60 days before the anticipated date of the
   88  change of ownership, the transferor must shall notify the agency
   89  of the intended change of ownership and the transferee must
   90  shall submit to the agency a Medicaid provider enrollment
   91  application. If a change of ownership occurs without compliance
   92  with the notice requirements of this subsection, the transferor
   93  and transferee are shall be jointly and severally liable for all
   94  overpayments, administrative fines, and other moneys due to the
   95  agency, regardless of whether the agency identified the
   96  overpayments, administrative fines, or other moneys before or
   97  after the effective date of the change of ownership. The agency
   98  may not approve a transferee’s Medicaid provider enrollment
   99  application if the transferee or transferor has not paid or
  100  agreed in writing to a payment plan for all outstanding
  101  overpayments, administrative fines, and other moneys due to the
  102  agency. This subsection does not preclude the agency from
  103  seeking any other legal or equitable remedies available to the
  104  agency for the recovery of moneys owed to the Medicaid program.
  105  In the event of a change of ownership involving a skilled
  106  nursing facility licensed under part II of chapter 400,
  107  liability for all outstanding overpayments, administrative
  108  fines, and any moneys owed to the agency before the effective
  109  date of the change of ownership shall be determined in
  110  accordance with s. 400.179 if the Medicaid provider enrollment
  111  application for change of ownership is submitted before the
  112  change of ownership.
  113         (c) As used in this subsection, the term:
  114         1.“Administrative fines” includes any amount identified in
  115  a notice of a monetary penalty or fine which has been issued by
  116  the agency or other regulatory or licensing agency that governs
  117  the provider.
  118         2.“Outstanding overpayment” includes any amount identified
  119  in a preliminary audit report issued to the transferor by the
  120  agency on or before the effective date of a change of ownership.
  121         (7) The agency may require, As a condition of participating
  122  in the Medicaid program and before entering into the provider
  123  agreement, the agency may require that the provider to submit
  124  information, in an initial and any required renewal
  125  applications, concerning the professional, business, and
  126  personal background of the provider and permit an onsite
  127  inspection of the provider’s service location by agency staff or
  128  other personnel designated by the agency to perform this
  129  function. Before entering into a provider agreement, the agency
  130  may shall perform an a random onsite inspection, within 60 days
  131  after receipt of a fully complete new provider’s application, of
  132  the provider’s service location prior to making its first
  133  payment to the provider for Medicaid services to determine the
  134  applicant’s ability to provide the services in compliance with
  135  the Medicaid program and professional regulations that the
  136  applicant is proposing to provide for Medicaid reimbursement.
  137  The agency is not required to perform an onsite inspection of a
  138  provider or program that is licensed by the agency, that
  139  provides services under waiver programs for home and community
  140  based services, or that is licensed as a medical foster home by
  141  the Department of Children and Family Services. As a continuing
  142  condition of participation in the Medicaid program, a provider
  143  must shall immediately notify the agency of any current or
  144  pending bankruptcy filing. Before entering into the provider
  145  agreement, or as a condition of continuing participation in the
  146  Medicaid program, the agency may also require that Medicaid
  147  providers reimbursed on a fee-for-services basis or fee schedule
  148  basis that which is not cost-based, post a surety bond not to
  149  exceed $50,000 or the total amount billed by the provider to the
  150  program during the current or most recent calendar year,
  151  whichever is greater. For new providers, the amount of the
  152  surety bond shall be determined by the agency based on the
  153  provider’s estimate of its first year’s billing. If the
  154  provider’s billing during the first year exceeds the bond
  155  amount, the agency may require the provider to acquire an
  156  additional bond equal to the actual billing level of the
  157  provider. A provider’s bond need shall not exceed $50,000 if a
  158  physician or group of physicians licensed under chapter 458,
  159  chapter 459, or chapter 460 has a 50 percent or greater
  160  ownership interest in the provider or if the provider is an
  161  assisted living facility licensed under chapter 429. The bonds
  162  permitted by this section are in addition to the bonds
  163  referenced in s. 400.179(2)(d). If the provider is a
  164  corporation, partnership, association, or other entity, the
  165  agency may require the provider to submit information concerning
  166  the background of that entity and of any principal of the
  167  entity, including any partner or shareholder having an ownership
  168  interest in the entity equal to 5 percent or greater, and any
  169  treating provider who participates in or intends to participate
  170  in Medicaid through the entity. The information must include:
  171         (a) Proof of holding a valid license or operating
  172  certificate, as applicable, if required by the state or local
  173  jurisdiction in which the provider is located or if required by
  174  the Federal Government.
  175         (b) Information concerning any prior violation, fine,
  176  suspension, termination, or other administrative action taken
  177  under the Medicaid laws or, rules, or regulations of this state
  178  or of any other state or the Federal Government; any prior
  179  violation of the laws or, rules, or regulations relating to the
  180  Medicare program; any prior violation of the rules or
  181  regulations of any other public or private insurer; and any
  182  prior violation of the laws or, rules, or regulations of any
  183  regulatory body of this or any other state.
  184         (c) Full and accurate disclosure of any financial or
  185  ownership interest that the provider, or any principal, partner,
  186  or major shareholder thereof, may hold in any other Medicaid
  187  provider or health care related entity or any other entity that
  188  is licensed by the state to provide health or residential care
  189  and treatment to persons.
  190         (d) If a group provider, identification of all members of
  191  the group and attestation that all members of the group are
  192  enrolled in or have applied to enroll in the Medicaid program.
  193         (8)(a) Each provider, or each principal of the provider if
  194  the provider is a corporation, partnership, association, or
  195  other entity, seeking to participate in the Medicaid program
  196  must submit a complete set of his or her fingerprints to the
  197  agency for the purpose of conducting a criminal history record
  198  check. Principals of the provider include any officer, director,
  199  billing agent, managing employee, or affiliated person, or any
  200  partner or shareholder who has an ownership interest equal to 5
  201  percent or more in the provider. However, for a hospital
  202  licensed under chapter 395 or a nursing home licensed under
  203  chapter 400, principals of the provider are those who meet the
  204  definition of a controlling interest under s. 408.803. A
  205  director of a not-for-profit corporation or organization is not
  206  a principal for purposes of a background investigation as
  207  required by this section if the director: serves solely in a
  208  voluntary capacity for the corporation or organization, does not
  209  regularly take part in the day-to-day operational decisions of
  210  the corporation or organization, receives no remuneration from
  211  the not-for-profit corporation or organization for his or her
  212  service on the board of directors, has no financial interest in
  213  the not-for-profit corporation or organization, and has no
  214  family members with a financial interest in the not-for-profit
  215  corporation or organization; and if the director submits an
  216  affidavit, under penalty of perjury, to this effect to the
  217  agency and the not-for-profit corporation or organization
  218  submits an affidavit, under penalty of perjury, to this effect
  219  to the agency as part of the corporation’s or organization’s
  220  Medicaid provider agreement application. Notwithstanding the
  221  above, the agency may require a background check for any person
  222  reasonably suspected by the agency to have been convicted of a
  223  crime.
  224         (a) This subsection does not apply to:
  225         1. A hospital licensed under chapter 395;
  226         2. A nursing home licensed under chapter 400;
  227         3. A hospice licensed under chapter 400;
  228         4. An assisted living facility licensed under chapter 429;
  229         1.5. A unit of local government, except that requirements
  230  of this subsection apply to nongovernmental providers and
  231  entities contracting with the local government to provide
  232  Medicaid services. The actual cost of the state and national
  233  criminal history record checks must be borne by the
  234  nongovernmental provider or entity; or
  235         2.6. Any business that derives more than 50 percent of its
  236  revenue from the sale of goods to the final consumer, and the
  237  business or its controlling parent is required to file a form
  238  10-K or other similar statement with the Securities and Exchange
  239  Commission or has a net worth of $50 million or more.
  240         (b) Background screening shall be conducted in accordance
  241  with chapter 435 and s. 408.809. The cost of the state and
  242  national criminal record check shall be borne by the provider.
  243         (c) Proof of compliance with the requirements of level 2
  244  screening under chapter 435 conducted within 12 months before
  245  the date the Medicaid provider application is submitted to the
  246  agency fulfills the requirements of this subsection.
  247         Section 2. Subsections (9), (13), (15), (16), (21), (22),
  248  (25), (28), (30) and (31) of section 409.913, Florida Statutes,
  249  are amended to read:
  250         409.913 Oversight of the integrity of the Medicaid
  251  program.—The agency shall operate a program to oversee the
  252  activities of Florida Medicaid recipients, and providers and
  253  their representatives, to ensure that fraudulent and abusive
  254  behavior and neglect of recipients occur to the minimum extent
  255  possible, and to recover overpayments and impose sanctions as
  256  appropriate. Beginning January 1, 2003, and each year
  257  thereafter, the agency and the Medicaid Fraud Control Unit of
  258  the Department of Legal Affairs shall submit a joint report to
  259  the Legislature documenting the effectiveness of the state’s
  260  efforts to control Medicaid fraud and abuse and to recover
  261  Medicaid overpayments during the previous fiscal year. The
  262  report must describe the number of cases opened and investigated
  263  each year; the sources of the cases opened; the disposition of
  264  the cases closed each year; the amount of overpayments alleged
  265  in preliminary and final audit letters; the number and amount of
  266  fines or penalties imposed; any reductions in overpayment
  267  amounts negotiated in settlement agreements or by other means;
  268  the amount of final agency determinations of overpayments; the
  269  amount deducted from federal claiming as a result of
  270  overpayments; the amount of overpayments recovered each year;
  271  the amount of cost of investigation recovered each year; the
  272  average length of time to collect from the time the case was
  273  opened until the overpayment is paid in full; the amount
  274  determined as uncollectible and the portion of the uncollectible
  275  amount subsequently reclaimed from the Federal Government; the
  276  number of providers, by type, that are terminated from
  277  participation in the Medicaid program as a result of fraud and
  278  abuse; and all costs associated with discovering and prosecuting
  279  cases of Medicaid overpayments and making recoveries in such
  280  cases. The report must also document actions taken to prevent
  281  overpayments and the number of providers prevented from
  282  enrolling in or reenrolling in the Medicaid program as a result
  283  of documented Medicaid fraud and abuse and must include policy
  284  recommendations necessary to prevent or recover overpayments and
  285  changes necessary to prevent and detect Medicaid fraud. All
  286  policy recommendations in the report must include a detailed
  287  fiscal analysis, including, but not limited to, implementation
  288  costs, estimated savings to the Medicaid program, and the return
  289  on investment. The agency must submit the policy recommendations
  290  and fiscal analyses in the report to the appropriate estimating
  291  conference, pursuant to s. 216.137, by February 15 of each year.
  292  The agency and the Medicaid Fraud Control Unit of the Department
  293  of Legal Affairs each must include detailed unit-specific
  294  performance standards, benchmarks, and metrics in the report,
  295  including projected cost savings to the state Medicaid program
  296  during the following fiscal year.
  297         (9) A Medicaid provider shall retain medical, professional,
  298  financial, and business records pertaining to services and goods
  299  furnished to a Medicaid recipient and billed to Medicaid for 6 a
  300  period of 5 years after the date of furnishing such services or
  301  goods. The agency may investigate, review, or analyze such
  302  records, which must be made available during normal business
  303  hours. However, 24-hour notice must be provided if patient
  304  treatment would be disrupted. The provider must keep is
  305  responsible for furnishing to the agency, and keeping the agency
  306  informed of the location of, the provider’s Medicaid-related
  307  records. The authority of the agency to obtain Medicaid-related
  308  records from a provider is neither curtailed nor limited during
  309  a period of litigation between the agency and the provider.
  310         (13) The agency shall immediately terminate participation
  311  of a Medicaid provider in the Medicaid program and may seek
  312  civil remedies or impose other administrative sanctions against
  313  a Medicaid provider, if the provider or any principal, officer,
  314  director, agent, managing employee, or affiliated person of the
  315  provider, or any partner or shareholder having an ownership
  316  interest in the provider equal to 5 percent or greater, has been
  317  convicted of a criminal offense under federal law or the law of
  318  any state relating to the practice of the provider’s profession,
  319  or a criminal offense listed under s. 409.907(10), s.
  320  408.809(4), or s. 435.04(2) has been:
  321         (a) Convicted of a criminal offense related to the delivery
  322  of any health care goods or services, including the performance
  323  of management or administrative functions relating to the
  324  delivery of health care goods or services;
  325         (b) Convicted of a criminal offense under federal law or
  326  the law of any state relating to the practice of the provider’s
  327  profession; or
  328         (c) Found by a court of competent jurisdiction to have
  329  neglected or physically abused a patient in connection with the
  330  delivery of health care goods or services. If the agency
  331  determines that the a provider did not participate or acquiesce
  332  in the an offense specified in paragraph (a), paragraph (b), or
  333  paragraph (c), termination will not be imposed. If the agency
  334  effects a termination under this subsection, the agency shall
  335  take final agency action issue an immediate final order pursuant
  336  to s. 120.569(2)(n).
  337         (15) The agency shall seek a remedy provided by law,
  338  including, but not limited to, any remedy provided in
  339  subsections (13) and (16) and s. 812.035, if:
  340         (a) The provider’s license has not been renewed, or has
  341  been revoked, suspended, or terminated, for cause, by the
  342  licensing agency of any state;
  343         (b) The provider has failed to make available or has
  344  refused access to Medicaid-related records to an auditor,
  345  investigator, or other authorized employee or agent of the
  346  agency, the Attorney General, a state attorney, or the Federal
  347  Government;
  348         (c) The provider has not furnished or has failed to make
  349  available such Medicaid-related records as the agency has found
  350  necessary to determine whether Medicaid payments are or were due
  351  and the amounts thereof;
  352         (d) The provider has failed to maintain medical records
  353  made at the time of service, or prior to service if prior
  354  authorization is required, demonstrating the necessity and
  355  appropriateness of the goods or services rendered;
  356         (e) The provider is not in compliance with provisions of
  357  Medicaid provider publications that have been adopted by
  358  reference as rules in the Florida Administrative Code; with
  359  provisions of state or federal laws, rules, or regulations; with
  360  provisions of the provider agreement between the agency and the
  361  provider; or with certifications found on claim forms or on
  362  transmittal forms for electronically submitted claims that are
  363  submitted by the provider or authorized representative, as such
  364  provisions apply to the Medicaid program;
  365         (f) The provider or person who ordered, authorized, or
  366  prescribed the care, services, or supplies has furnished, or
  367  ordered or authorized the furnishing of, goods or services to a
  368  recipient which are inappropriate, unnecessary, excessive, or
  369  harmful to the recipient or are of inferior quality;
  370         (g) The provider has demonstrated a pattern of failure to
  371  provide goods or services that are medically necessary;
  372         (h) The provider or an authorized representative of the
  373  provider, or a person who ordered, authorized, or prescribed the
  374  goods or services, has submitted or caused to be submitted false
  375  or a pattern of erroneous Medicaid claims;
  376         (i) The provider or an authorized representative of the
  377  provider, or a person who has ordered, authorized, or prescribed
  378  the goods or services, has submitted or caused to be submitted a
  379  Medicaid provider enrollment application, a request for prior
  380  authorization for Medicaid services, a drug exception request,
  381  or a Medicaid cost report that contains materially false or
  382  incorrect information;
  383         (j) The provider or an authorized representative of the
  384  provider has collected from or billed a recipient or a
  385  recipient’s responsible party improperly for amounts that should
  386  not have been so collected or billed by reason of the provider’s
  387  billing the Medicaid program for the same service;
  388         (k) The provider or an authorized representative of the
  389  provider has included in a cost report costs that are not
  390  allowable under a Florida Title XIX reimbursement plan, after
  391  the provider or authorized representative had been advised in an
  392  audit exit conference or audit report that the costs were not
  393  allowable;
  394         (l) The provider is charged by information or indictment
  395  with fraudulent billing practices or an offense referenced in
  396  subsection (13). The sanction applied for this reason is limited
  397  to suspension of the provider’s participation in the Medicaid
  398  program for the duration of the indictment unless the provider
  399  is found guilty pursuant to the information or indictment;
  400         (m) The provider or a person who has ordered, authorized,
  401  or prescribed the goods or services is found liable for
  402  negligent practice resulting in death or injury to the
  403  provider’s patient;
  404         (n) The provider fails to demonstrate that it had available
  405  during a specific audit or review period sufficient quantities
  406  of goods, or sufficient time in the case of services, to support
  407  the provider’s billings to the Medicaid program;
  408         (o) The provider has failed to comply with the notice and
  409  reporting requirements of s. 409.907;
  410         (p) The agency has received reliable information of patient
  411  abuse or neglect or of any act prohibited by s. 409.920; or
  412         (q) The provider has failed to comply with an agreed-upon
  413  repayment schedule.
  414  
  415  A provider is subject to sanctions for violations of this
  416  subsection as the result of actions or inactions of the
  417  provider, or actions or inactions of any principal, officer,
  418  director, agent, managing employee, or affiliated person of the
  419  provider, or any partner or shareholder having an ownership
  420  interest in the provider equal to 5 percent or greater, in which
  421  the provider participated or acquiesced.
  422         (16) The agency shall impose any of the following sanctions
  423  or disincentives on a provider or a person for any of the acts
  424  described in subsection (15):
  425         (a) Suspension for a specific period of time of not more
  426  than 1 year. Suspension precludes shall preclude participation
  427  in the Medicaid program, which includes any action that results
  428  in a claim for payment to the Medicaid program for as a result
  429  of furnishing, supervising a person who is furnishing, or
  430  causing a person to furnish goods or services.
  431         (b) Termination for a specific period of time ranging of
  432  from more than 1 year to 20 years. Termination precludes shall
  433  preclude participation in the Medicaid program, which includes
  434  any action that results in a claim for payment to the Medicaid
  435  program for as a result of furnishing, supervising a person who
  436  is furnishing, or causing a person to furnish goods or services.
  437         (c) Imposition of a fine of up to $5,000 for each
  438  violation. Each day that an ongoing violation continues, such as
  439  refusing to furnish Medicaid-related records or refusing access
  440  to records, is considered, for the purposes of this section, to
  441  be a separate violation. Each instance of improper billing of a
  442  Medicaid recipient; each instance of including an unallowable
  443  cost on a hospital or nursing home Medicaid cost report after
  444  the provider or authorized representative has been advised in an
  445  audit exit conference or previous audit report of the cost
  446  unallowability; each instance of furnishing a Medicaid recipient
  447  goods or professional services that are inappropriate or of
  448  inferior quality as determined by competent peer judgment; each
  449  instance of knowingly submitting a materially false or erroneous
  450  Medicaid provider enrollment application, request for prior
  451  authorization for Medicaid services, drug exception request, or
  452  cost report; each instance of inappropriate prescribing of drugs
  453  for a Medicaid recipient as determined by competent peer
  454  judgment; and each false or erroneous Medicaid claim leading to
  455  an overpayment to a provider is considered, for the purposes of
  456  this section, to be a separate violation.
  457         (d) Immediate suspension, if the agency has received
  458  information of patient abuse or neglect or of any act prohibited
  459  by s. 409.920. Upon suspension, the agency must issue an
  460  immediate final order under s. 120.569(2)(n).
  461         (e) A fine, not to exceed $10,000, for a violation of
  462  paragraph (15)(i).
  463         (f) Imposition of liens against provider assets, including,
  464  but not limited to, financial assets and real property, not to
  465  exceed the amount of fines or recoveries sought, upon entry of
  466  an order determining that such moneys are due or recoverable.
  467         (g) Prepayment reviews of claims for a specified period of
  468  time.
  469         (h) Comprehensive followup reviews of providers every 6
  470  months to ensure that they are billing Medicaid correctly.
  471         (i) Corrective-action plans that would remain in effect for
  472  providers for up to 3 years and that are would be monitored by
  473  the agency every 6 months while in effect.
  474         (j) Other remedies as permitted by law to effect the
  475  recovery of a fine or overpayment.
  476  
  477  If a provider voluntarily relinquishes its Medicaid provider
  478  number or an associated license, or allows the associated
  479  licensure to expire after receiving written notice that the
  480  agency is conducting, or has conducted, an audit, survey,
  481  inspection, or investigation and that a sanction of suspension
  482  or termination will or would be imposed for noncompliance
  483  discovered as a result of the audit, survey, inspection, or
  484  investigation, the agency shall impose the sanction of
  485  termination for cause against the provider. The Secretary of
  486  Health Care Administration may make a determination that
  487  imposition of a sanction or disincentive is not in the best
  488  interest of the Medicaid program, in which case a sanction or
  489  disincentive may shall not be imposed.
  490         (21) When making a determination that an overpayment has
  491  occurred, the agency shall prepare and issue an audit report to
  492  the provider showing the calculation of overpayments. The
  493  agency’s determination must be based solely upon information
  494  available to it before issuance of the audit report and, in the
  495  case of documentation obtained to substantiate claims for
  496  Medicaid reimbursement, based solely upon contemporaneous
  497  records.
  498         (22) The audit report, supported by agency work papers,
  499  showing an overpayment to a provider constitutes evidence of the
  500  overpayment. A provider may not present or elicit testimony,
  501  either on direct examination or cross-examination in any court
  502  or administrative proceeding, regarding the purchase or
  503  acquisition by any means of drugs, goods, or supplies; sales or
  504  divestment by any means of drugs, goods, or supplies; or
  505  inventory of drugs, goods, or supplies, unless such acquisition,
  506  sales, divestment, or inventory is documented by written
  507  invoices, written inventory records, or other competent written
  508  documentary evidence maintained in the normal course of the
  509  provider’s business. A provider may not present records to
  510  contest an overpayment or sanction unless such records are
  511  contemporaneous and, if requested during the audit process, were
  512  furnished to the agency or its agent upon request. This
  513  limitation does not apply to Medicaid cost report audits.
  514  Notwithstanding the applicable rules of discovery, all
  515  documentation to that will be offered as evidence at an
  516  administrative hearing on a Medicaid overpayment or an
  517  administrative sanction must be exchanged by all parties at
  518  least 14 days before the administrative hearing or must be
  519  excluded from consideration.
  520         (25)(a) The agency shall withhold Medicaid payments, in
  521  whole or in part, to a provider upon receipt of reliable
  522  evidence that the circumstances giving rise to the need for a
  523  withholding of payments involve fraud, willful
  524  misrepresentation, or abuse under the Medicaid program, or a
  525  crime committed while rendering goods or services to Medicaid
  526  recipients. If it is determined that fraud, willful
  527  misrepresentation, abuse, or a crime did not occur, the payments
  528  withheld must be paid to the provider within 14 days after such
  529  determination with interest at the rate of 10 percent a year.
  530  Any money withheld in accordance with this paragraph shall be
  531  placed in a suspended account, readily accessible to the agency,
  532  so that any payment ultimately due the provider shall be made
  533  within 14 days. Amounts not paid within 14 days accrue interest
  534  at the rate of 10 percent a year, beginning after the 14th day.
  535         (b) The agency shall deny payment, or require repayment, if
  536  the goods or services were furnished, supervised, or caused to
  537  be furnished by a person who has been suspended or terminated
  538  from the Medicaid program or Medicare program by the Federal
  539  Government or any state.
  540         (c) Overpayments owed to the agency bear interest at the
  541  rate of 10 percent per year from the date of final determination
  542  of the overpayment by the agency, and payment arrangements must
  543  be made within 30 days after the date of the final order, which
  544  is not subject to further appeal at the conclusion of legal
  545  proceedings. A provider who does not enter into or adhere to an
  546  agreed-upon repayment schedule may be terminated by the agency
  547  for nonpayment or partial payment.
  548         (d) The agency, upon entry of a final agency order, a
  549  judgment or order of a court of competent jurisdiction, or a
  550  stipulation or settlement, may collect the moneys owed by all
  551  means allowable by law, including, but not limited to, notifying
  552  any fiscal intermediary of Medicare benefits that the state has
  553  a superior right of payment. Upon receipt of such written
  554  notification, the Medicare fiscal intermediary shall remit to
  555  the state the sum claimed.
  556         (e) The agency may institute amnesty programs to allow
  557  Medicaid providers the opportunity to voluntarily repay
  558  overpayments. The agency may adopt rules to administer such
  559  programs.
  560         (28) Venue for all Medicaid program integrity overpayment
  561  cases lies shall lie in Leon County, at the discretion of the
  562  agency.
  563         (30) The agency shall terminate a provider’s participation
  564  in the Medicaid program if the provider fails to reimburse an
  565  overpayment or pay an agency-imposed fine that has been
  566  determined by final order, not subject to further appeal, within
  567  30 35 days after the date of the final order, unless the
  568  provider and the agency have entered into a repayment agreement.
  569         (31) If a provider requests an administrative hearing
  570  pursuant to chapter 120, such hearing must be conducted within
  571  90 days following assignment of an administrative law judge,
  572  absent exceptionally good cause shown as determined by the
  573  administrative law judge or hearing officer. Upon issuance of a
  574  final order, the outstanding balance of the amount determined to
  575  constitute the overpayment and fines is shall become due. If a
  576  provider fails to make payments in full, fails to enter into a
  577  satisfactory repayment plan, or fails to comply with the terms
  578  of a repayment plan or settlement agreement, the agency shall
  579  withhold medical assistance reimbursement payments for Medicaid
  580  services until the amount due is paid in full.
  581         Section 3. Subsection (8) of section 409.920, Florida
  582  Statutes, is amended to read:
  583         409.920 Medicaid provider fraud.—
  584         (8) A person who provides the state, any state agency, any
  585  of the state’s political subdivisions, or any agency of the
  586  state’s political subdivisions with information about fraud or
  587  suspected fraudulent acts fraud by a Medicaid provider,
  588  including a managed care organization, is immune from civil
  589  liability for libel, slander, or any other relevant tort for
  590  providing the information about fraud or suspected fraudulent
  591  acts, unless the person acted with knowledge that the
  592  information was false or with reckless disregard for the truth
  593  or falsity of the information. Such immunity extends to reports
  594  of fraudulent acts or suspected fraudulent acts conveyed to or
  595  from the agency in any manner, including any forum and with any
  596  audience as directed by the agency, and includes all discussions
  597  subsequent to the report and subsequent inquiries from the
  598  agency, unless the person acted with knowledge that the
  599  information was false or with reckless disregard for the truth
  600  or falsity of the information. For purposes of this subsection,
  601  the term “fraudulent acts” includes actual or suspected fraud
  602  and abuse, insurance fraud, licensure fraud, or public
  603  assistance fraud, including any fraud-related matters that a
  604  provider or health plan is required to report to the agency or a
  605  law enforcement agency.
  606         Section 4. This act shall take effect July 1, 2013.