Audit: Florida Medicaid paid insurance companies for dead people

Florida’s Medicaid Program has come under criticism repeatedly in recent years for its failure to provide for the care of disabled and poor children in the state.

But it appears if you are dead, the state is willing to pay — especially if that money is landing in the pockets of insurance companies.

Florida is shifting all Medicaid recipients into managed care plans. First up: Nursing home and long-term-care recipients.
When Florida shifted all Medicaid recipients into managed care plans, it ended up paying HMOs $26 million for enrollees who had died.

A federal audit released Tuesday reported that over a five-year period the state’s Medicaid program overpaid HMS $26 million in monthly premiums for enrollees who had passed to the great beyond.

Florida Health News reports it appears monthly Medicaid premiums were paid for several thousands of Floridians who had died.

Medicaid is funded by the state and federal government — and the federal government wants its money back.

Officials with the Department of Health and Human Services said the Florida’s Agency for Health Care Administration needs to pay back $15 million in money lost through operational costs.

AHCA says it has already corrected the problem, recouping almost $24 million of the $26 million in overpayments — a 98 percent success rate.

The five-year period covers a time when Florida Medicaid was changing from a traditional fee-based model to a statewide managed care for all Medicaid participants. The state agency paid HMOs about $1.3 billion from July 1, 2009 through Nov. 5, 2014, the report found.

If you want to read more on the audit, click the Florida Health News Story here.

Florida Auditor General releases report on Health Care District

The state Auditor General released the much-anticipated report on the Health Care District of Palm Beach County — and despite resurrecting some ghosts of scandals past — this latest in a long line of audits found little new.

DarcyDavis
New CEO of the Health Care District Darcy Davis says taxpayers should be thrilled with the recent report from the State Auditor General that resurrected some old scandals but found little new.

The audit recommended the district get reimbursed for using the air ambulance Trauma Hawk out of county and put in conflict of interest safeguards when purchasing land or giving money away to outreach organizations. It also recommended increased independence when it comes to its internal audits.

Dave-Kerner-307
Rep. Dave Kerner of Lake Worth – and county commission candidate – wanted Trauma Hawk placed under the power of the Sheriff’s Office.

The district has undergone a series of audits in about a year and this latest one was a political animal stemming from a takeover attempt last year by the Sheriff’s Office of Trauma Hawk. That coup failed, but one of its most ardent supporters, Lake Worth state Rep. Dave Kerner, called for an audit.

For Darcy Davis, the newly enthroned CEO of the district, the Auditor General’s report was a good start to her tenure. It is especially good news when compared to what has happen to the south with scandal-plagued Broward Health where the chair was removed by Gov. Rick Scott last month and then ordered reinstated by a judge on Monday.

“The taxpayers should be pleased that this is all the Auditor General would find,” she said. “Not to minimize their efforts, but seriously this gives me reassurance that the tax dollars are being used wisely.”

The report alludes to a scandal five years ago when the district spurned free county land to rebuild the Edward J. Healey Rehabilitation and Nursing Center at its existing – but problematic – site. Instead, the district purchased land for $4 million in which the family of the real estate broker for the district had an interest.

On Trauma Hawk, the report did say that not all out-of-county services were trauma-related, and thus were not reimbursed. The county footed about $452,500 for counties that called in for help.

Davis said that the District will renew negotiations with other counties, but it is a tough task since withholding such services could cost lives.