Bill Amendment: FL S0844 | 2013 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Medicaid
Status: 2013-04-29 - Laid on Table, companion bill(s) passed, see CS/CS/HB 939 (Ch. 2013-150), SB 1520 (Ch. 2013-48) [S0844 Detail]
Download: Florida-2013-S0844-Appropriations_Subcommittee_on_Health_and_Human_Services_Committee_Amendment_Delete_All_531582.html
Bill Title: Medicaid
Status: 2013-04-29 - Laid on Table, companion bill(s) passed, see CS/CS/HB 939 (Ch. 2013-150), SB 1520 (Ch. 2013-48) [S0844 Detail]
Download: Florida-2013-S0844-Appropriations_Subcommittee_on_Health_and_Human_Services_Committee_Amendment_Delete_All_531582.html
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 6a23period of 5years 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 toas the resultofa 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 isIn the event ofa 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 changeof ownership.In42addition 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 this46subsection, the term “outstanding overpayment” includes any47amount identified in a preliminary audit report issued to the48transferor by the agency on or before the effective date of the49change 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 mustshallnotify the agency 61 of the intended changeof ownershipand the transferee must 62shallsubmit 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 areshall bejointly 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 changeof 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 changeof 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 requirethatthe 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 mayshallperform ana randomonsite inspection, within 60 days103after receipt of a fully complete new provider’s application,of 104 the provider’s service locationprior to making its first105payment to the provider for Medicaid servicesto determine the 106 applicant’s ability to provide the services in compliance with 107 the Medicaid program and professional regulationsthat the108applicant is proposing to provide for Medicaid reimbursement. 109The agency is not required to perform an onsite inspection of a110provider or program that is licensed by the agency, that111provides services under waiver programs for home and community-112based services, or that is licensed as a medical foster home by113the Department of Children and Family Services.As a continuing 114 condition of participation in the Medicaid program, a provider 115 mustshallimmediately 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 requirethatMedicaid 119 providers that are reimbursed on a fee-for-services basis or fee 120 schedule basis thatwhichis 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 needshallnot 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 regulationsof this state 150 orofany other state or the Federal Government; any prior 151 violation of the laws or,rules, or regulationsrelating to the 152 Medicare program; any prior violation of the rulesor153regulationsof any other public or private insurer; and any 154 prior violation of the laws or,rules, or regulationsof 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 investigationas179 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: 1971. A hospital licensed under chapter 395;1982. A nursing home licensed under chapter 400;1993. A hospice licensed under chapter 400;2004. 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) Proofof compliance with the requirements of level 2216screening under chapter 435 conducted within 12 months before217the date the Medicaid provider application is submitted to the218agency 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 222either: 223 (a) Enroll the applicant as a Medicaid provider upon 224 approval of the provider application. The enrollment effective 225 date isshall bethe 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 applyingany andall 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 thisthestateof Floridaif the provider’s location is 242 no more than 50 miles from theFloridastate 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 proceedstherefromfor a 283 covered illness or injury, mustis required either to pay the284agency, within 60 days after receipt of settlement proceeds, pay 285 the agency the full amount of the third-party benefits, but not 286 more thanin excess ofthe total medical assistance provided by 287 Medicaid, ortoplace the full amount of the third-party 288 benefits in an interest-bearingatrust account for the benefit 289 of the agency pending anjudicial oradministrative 290 determination of the agency’s right to the benefitsthereto. 291 Proof thatanysuch person had notice or knowledge that the 292 recipient had received medical assistance from Medicaid, and 293 that third-party benefits or proceedstherefromwere in any way 294 related to a covered illness or injury for which Medicaid had 295 provided medical assistance, and thatanysuch person knowingly 296 obtained possession or control of, or used, third-party benefits 297 or proceeds and failedeitherto 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 anjudicial oradministrative 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 mayis authorized toinvestigate andto348 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 6a427period of 5years 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 keepis432responsible for furnishing to the agency, and keepingthe 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 shallimmediatelyterminate 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 delivery449of any health care goods or services, including the performance450of management or administrative functions relating to the451delivery of health care goods or services;452(b) Convicted of a criminal offense under federal law or453the law of any state relating to the practice of the provider’s454profession; or455(c) Found by a court of competent jurisdiction to have456neglected or physically abused a patient in connection with the457delivery of health care goods or services. If the agency 458 determines that theaprovider did not participate or acquiesce 459 in theanoffensespecified in paragraph (a), paragraph (b), or460paragraph (c), termination will not be imposed. If the agency 461 effects a termination under this subsection, the agency shall 462 take final agency actionissue an immediate final order pursuant463to 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 whohasordered, 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 precludesshall precludeparticipation 554 in the Medicaid program, which includes any action that results 555 in a claim for payment to the Medicaid program foras a result556offurnishing, 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 rangingof559 from more than 1 year to 20 years. Termination precludesshall560precludeparticipation in the Medicaid program, which includes 561 any action that results in a claim for payment to the Medicaid 562 program foras a result offurnishing, 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, to568bea 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 of583this section, to bea 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 thatwouldremain in effectfor599providersfor up to 3 years and that arewould bemonitored 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 mayshallnot 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,628eitheron 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 tothat willbe 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 ormustbe 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 determinationwith 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 dayAny money659withheld in accordance with this paragraph shall be placed in a660suspended account, readily accessible to the agency, so that any661payment ultimately due the provider shall be made within 14662days. 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 appealat the conclusion of legal673proceedings.A provider who does not enter into or adhere to an674agreed-upon repayment schedule may be terminated by the agency675for 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 integrityoverpayment689 cases liesshall liein 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 3035days 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 isshall becomedue. 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 withholdmedical assistancereimbursement 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 actsfraudby 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 providingtheinformation 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 memberwho may not740designate 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.