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Governor Scott Wants Audits of Medicaid-Managed Contracts

In an arguably surprising move, Governor Rick Scott wants many hospitals in the state to undergo random audits of their Medicaid contracts. This decision comes hand in hand with the state’s desire to investigate nearly 130 hospitals to ensure they are not violating Florida law. The governor has specifically asked the state Department of Health to forward “any contracts where we find suspicion of fraud or abuse” to the attorney general’s office.

Why is this important? There is a high probability these audits will uncover systemic fraud throughout the major hospital chains in Florida. Medicaid contracts are negotiated directly between the hospital and the health plan provider. As such, details such as providers, rate limits, insurance caps, etc. are all kept relatively confidential. There is no requirement the contracts be disclosed to the public. The lack of transparency, arguably, can lead to more frequent incidents of fraudulent behavior – which is exactly what the auditors are hoping to catch.

The state is particularly concerned about hospitals with contracts that illegally exceed provider rate limits because then they will seek higher rate payments from the state (for reimbursement). Again, this is not surprising, as the governor is currently stuck in tough negotiations with the health insurance companies over the reimbursement rates. The insurers are being accused of setting up unreasonably high rates in their hospital contracts (rates that exceed the 120% cap provided for in state law), thus draining the funding available for providing medical care to the disadvantaged.

Because it is unclear how in-depth these audits will be, it is important to be prepared in case your hospital or insurance provider contract is found to be suspected of abuse or fraud. The state authorities will engage in a full investigation, if that is the casel and will look to subpoena large amounts of documents, patient and billing information. If this does happen, you are at risk of a criminal or civil investigation for health care fraud.

If you think you need a lawyer, YOU DO. Call Now!

Are you looking for a skilled attorney who can help defend you against any type of fraud charges? Please contact Attorney Tony Moss at the Tony Moss Firm, L.L.C. to discuss these, or any other defense matters. He has locations in Miami and Fort Lauderdale, and is prepared to put his 27 years of experience to work for you.

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