Bill Text: FL S0844 | 2013 | Regular Session | Comm Sub


Bill Title: Medicaid

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced - Dead) 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-Comm_Sub.html
       Florida Senate - 2013                       CS for CS for SB 844
       
       
       
       By the Committees on Appropriations; and Health Policy; and
       Senator Grimsley
       
       
       
       576-04909-13                                           2013844c2
    1                        A bill to be entitled                      
    2         An act relating to Medicaid; amending s. 409.907,
    3         F.S.; adding an additional provision relating to a
    4         change in principal that must be included in a
    5         Medicaid provider agreement with the Agency for Health
    6         Care Administration; adding the definitions of the
    7         terms “administrative fines” and “outstanding
    8         overpayment”; revising provisions relating to the
    9         agency’s onsite inspection responsibilities; revising
   10         provisions relating to who is subject to background
   11         screening; authorizing the agency to enroll a provider
   12         who is licensed in this state and provides diagnostic
   13         services through telecommunications technology;
   14         amending s. 409.910, F.S.; revising provisions
   15         relating to responsibility for Medicaid payments in
   16         settlement proceedings; providing procedures for a
   17         recipient to contest the amount payable to the agency;
   18         amending s. 409.913, F.S.; revising provisions
   19         specifying grounds for terminating a provider from the
   20         program, for seeking certain remedies for violations,
   21         and for imposing certain sanctions; providing a
   22         limitation on the information the agency may consider
   23         when making a determination of overpayment; specifying
   24         the type of records a provider must present to contest
   25         an overpayment; deleting the requirement that the
   26         agency place payments withheld from a provider in a
   27         suspended account and revising when a provider must
   28         reimburse overpayments; revising venue requirements;
   29         adding provisions relating to the payment of fines;
   30         amending s. 409.920, F.S.; clarifying provisions
   31         relating to immunity from liability for persons who
   32         provide information about Medicaid fraud; amending s.
   33         624.351, F.S.; providing for the expiration of the
   34         Medicaid and Public Assistance Fraud Strike Force;
   35         amending s. 624.352, F.S.; providing for the
   36         expiration of provisions relating to “Strike Force”
   37         agreements; providing an effective date.
   38  
   39  Be It Enacted by the Legislature of the State of Florida:
   40  
   41         Section 1. Paragraph (c) of subsection (3) of section
   42  409.907, Florida Statutes, is amended, paragraph (k) is added to
   43  that subsection, and subsections (6) through (9) of that section
   44  are amended, to read:
   45         409.907 Medicaid provider agreements.—The agency may make
   46  payments for medical assistance and related services rendered to
   47  Medicaid recipients only to an individual or entity who has a
   48  provider agreement in effect with the agency, who is performing
   49  services or supplying goods in accordance with federal, state,
   50  And local law, and who agrees that no person shall, on the
   51  grounds of handicap, race, color, or national origin, or for any
   52  other reason, be subjected to discrimination under any program
   53  or activity for which the provider receives payment from the
   54  agency.
   55         (3) The provider agreement developed by the agency, in
   56  addition to the requirements specified in subsections (1) and
   57  (2), shall require the provider to:
   58         (c) Retain all medical and Medicaid-related records for a
   59  period of 5 years to satisfy all necessary inquiries by the
   60  agency.
   61         (k) Report a change in any principal of the provider,
   62  including any officer, director, agent, managing employee, or
   63  affiliated person, or any partner or shareholder who has an
   64  ownership interest equal to 5 percent or more in the provider,
   65  to the agency in writing within 30 days after the change occurs.
   66  For a hospital licensed under chapter 395 or a nursing home
   67  licensed under part II of chapter 400, a principal of the
   68  provider is one who meets the definition of a controlling
   69  interest under s. 408.803.
   70         (6) A Medicaid provider agreement may be revoked, at the
   71  option of the agency, due to as the result of a change of
   72  ownership of any facility, association, partnership, or other
   73  entity named as the provider in the provider agreement.
   74         (a) If there is In the event of a change of ownership, the
   75  transferor remains liable for all outstanding overpayments,
   76  administrative fines, and any other moneys owed to the agency
   77  before the effective date of the change of ownership. In
   78  addition to the continuing liability of the transferor, The
   79  transferee is also liable to the agency for all outstanding
   80  overpayments identified by the agency on or before the effective
   81  date of the change of ownership. For purposes of this
   82  subsection, the term “outstanding overpayment” includes any
   83  amount identified in a preliminary audit report issued to the
   84  transferor by the agency on or before the effective date of the
   85  change of ownership. In the event of a change of ownership for a
   86  skilled nursing facility or intermediate care facility, the
   87  Medicaid provider agreement shall be assigned to the transferee
   88  if the transferee meets all other Medicaid provider
   89  qualifications. In the event of a change of ownership involving
   90  a skilled nursing facility licensed under part II of chapter
   91  400, liability for all outstanding overpayments, administrative
   92  fines, and any moneys owed to the agency before the effective
   93  date of the change of ownership shall be determined in
   94  accordance with s. 400.179.
   95         (b) At least 60 days before the anticipated date of the
   96  change of ownership, the transferor must shall notify the agency
   97  of the intended change of ownership and the transferee must
   98  shall submit to the agency a Medicaid provider enrollment
   99  application. If a change of ownership occurs without compliance
  100  with the notice requirements of this subsection, the transferor
  101  and transferee are shall be jointly and severally liable for all
  102  overpayments, administrative fines, and other moneys due to the
  103  agency, regardless of whether the agency identified the
  104  overpayments, administrative fines, or other moneys before or
  105  after the effective date of the change of ownership. The agency
  106  may not approve a transferee’s Medicaid provider enrollment
  107  application if the transferee or transferor has not paid or
  108  agreed in writing to a payment plan for all outstanding
  109  overpayments, administrative fines, and other moneys due to the
  110  agency. This subsection does not preclude the agency from
  111  seeking any other legal or equitable remedies available to the
  112  agency for the recovery of moneys owed to the Medicaid program.
  113  In the event of a change of ownership involving a skilled
  114  nursing facility licensed under part II of chapter 400,
  115  liability for all outstanding overpayments, administrative
  116  fines, and any moneys owed to the agency before the effective
  117  date of the change of ownership shall be determined in
  118  accordance with s. 400.179 if the Medicaid provider enrollment
  119  application for change of ownership is submitted before the
  120  change of ownership.
  121         (c) As used in this subsection, the term:
  122         1. “Administrative fines” includes any amount identified in
  123  a notice of a monetary penalty or fine which has been issued by
  124  the agency or other regulatory or licensing agency that governs
  125  the provider.
  126         2. “Outstanding overpayment” includes any amount identified
  127  in a preliminary audit report issued to the transferor by the
  128  agency on or before the effective date of a change of ownership.
  129         (7) The agency may require, As a condition of participating
  130  in the Medicaid program and before entering into the provider
  131  agreement, the agency may require that the provider to submit
  132  information, in an initial and any required renewal
  133  applications, concerning the professional, business, and
  134  personal background of the provider and permit an onsite
  135  inspection of the provider’s service location by agency staff or
  136  other personnel designated by the agency to perform this
  137  function. Before entering into a provider agreement, the agency
  138  may shall perform an a random onsite inspection, within 60 days
  139  after receipt of a fully complete new provider’s application, of
  140  the provider’s service location prior to making its first
  141  payment to the provider for Medicaid services to determine the
  142  applicant’s ability to provide the services in compliance with
  143  the Medicaid program and professional regulations that the
  144  applicant is proposing to provide for Medicaid reimbursement.
  145  The agency is not required to perform an onsite inspection of a
  146  provider or program that is licensed by the agency, that
  147  provides services under waiver programs for home and community-
  148  based services, or that is licensed as a medical foster home by
  149  the Department of Children and Family Services. As a continuing
  150  condition of participation in the Medicaid program, a provider
  151  must shall immediately notify the agency of any current or
  152  pending bankruptcy filing. Before entering into the provider
  153  agreement, or as a condition of continuing participation in the
  154  Medicaid program, the agency may also require that Medicaid
  155  providers that are reimbursed on a fee-for-services basis or fee
  156  schedule basis that which is not cost-based to, post a surety
  157  bond not to exceed $50,000 or the total amount billed by the
  158  provider to the program during the current or most recent
  159  calendar year, whichever is greater. For new providers, the
  160  amount of the surety bond shall be determined by the agency
  161  based on the provider’s estimate of its first year’s billing. If
  162  the provider’s billing during the first year exceeds the bond
  163  amount, the agency may require the provider to acquire an
  164  additional bond equal to the actual billing level of the
  165  provider. A provider’s bond need shall not exceed $50,000 if a
  166  physician or group of physicians licensed under chapter 458,
  167  chapter 459, or chapter 460 has a 50 percent or greater
  168  ownership interest in the provider or if the provider is an
  169  assisted living facility licensed under chapter 429. The bonds
  170  permitted by this section are in addition to the bonds
  171  referenced in s. 400.179(2)(d). If the provider is a
  172  corporation, partnership, association, or other entity, the
  173  agency may require the provider to submit information concerning
  174  the background of that entity and of any principal of the
  175  entity, including any partner or shareholder having an ownership
  176  interest in the entity equal to 5 percent or greater, and any
  177  treating provider who participates in or intends to participate
  178  in Medicaid through the entity. The information must include:
  179         (a) Proof of holding a valid license or operating
  180  certificate, as applicable, if required by the state or local
  181  jurisdiction in which the provider is located or if required by
  182  the Federal Government.
  183         (b) Information concerning any prior violation, fine,
  184  suspension, termination, or other administrative action taken
  185  under the Medicaid laws or, rules, or regulations of this state
  186  or of any other state or the Federal Government; any prior
  187  violation of the laws or, rules, or regulations relating to the
  188  Medicare program; any prior violation of the rules or
  189  regulations of any other public or private insurer; and any
  190  prior violation of the laws or, rules, or regulations of any
  191  regulatory body of this or any other state.
  192         (c) Full and accurate disclosure of any financial or
  193  ownership interest that the provider, or any principal, partner,
  194  or major shareholder thereof, may hold in any other Medicaid
  195  provider or health care related entity or any other entity that
  196  is licensed by the state to provide health or residential care
  197  and treatment to persons.
  198         (d) If a group provider, identification of all members of
  199  the group and attestation that all members of the group are
  200  enrolled in or have applied to enroll in the Medicaid program.
  201         (8)(a) Each provider, or each principal of the provider if
  202  the provider is a corporation, partnership, association, or
  203  other entity, seeking to participate in the Medicaid program
  204  must submit a complete set of his or her fingerprints to the
  205  agency for the purpose of conducting a criminal history record
  206  check. Principals of the provider include any officer, director,
  207  billing agent, managing employee, or affiliated person, or any
  208  partner or shareholder who has an ownership interest equal to 5
  209  percent or more in the provider. However, for a hospital
  210  licensed under chapter 395 or a nursing home licensed under
  211  chapter 400, principals of the provider are those who meet the
  212  definition of a controlling interest under s. 408.803. A
  213  director of a not-for-profit corporation or organization is not
  214  a principal for purposes of a background investigation as
  215  required by this section if the director: serves solely in a
  216  voluntary capacity for the corporation or organization, does not
  217  regularly take part in the day-to-day operational decisions of
  218  the corporation or organization, receives no remuneration from
  219  the not-for-profit corporation or organization for his or her
  220  service on the board of directors, has no financial interest in
  221  the not-for-profit corporation or organization, and has no
  222  family members with a financial interest in the not-for-profit
  223  corporation or organization; and if the director submits an
  224  affidavit, under penalty of perjury, to this effect to the
  225  agency and the not-for-profit corporation or organization
  226  submits an affidavit, under penalty of perjury, to this effect
  227  to the agency as part of the corporation’s or organization’s
  228  Medicaid provider agreement application. Notwithstanding the
  229  above, the agency may require a background check for any person
  230  reasonably suspected by the agency to have been convicted of a
  231  crime.
  232         (a) This subsection does not apply to:
  233         1. A hospital licensed under chapter 395;
  234         2. A nursing home licensed under chapter 400;
  235         3. A hospice licensed under chapter 400;
  236         4. An assisted living facility licensed under chapter 429;
  237         1.5. A unit of local government, except that requirements
  238  of this subsection apply to nongovernmental providers and
  239  entities contracting with the local government to provide
  240  Medicaid services. The actual cost of the state and national
  241  criminal history record checks must be borne by the
  242  nongovernmental provider or entity; or
  243         2.6. Any business that derives more than 50 percent of its
  244  revenue from the sale of goods to the final consumer, and the
  245  business or its controlling parent is required to file a form
  246  10-K or other similar statement with the Securities and Exchange
  247  Commission or has a net worth of $50 million or more.
  248         (b) Background screening shall be conducted in accordance
  249  with chapter 435 and s. 408.809. The cost of the state and
  250  national criminal record check shall be borne by the provider.
  251         (c) Proof of compliance with the requirements of level 2
  252  screening under chapter 435 conducted within 12 months before
  253  the date the Medicaid provider application is submitted to the
  254  agency fulfills the requirements of this subsection.
  255         (9) Upon receipt of a completed, signed, and dated
  256  application, and completion of any necessary background
  257  investigation and criminal history record check, the agency must
  258  either:
  259         (a) Enroll the applicant as a Medicaid provider upon
  260  approval of the provider application. The enrollment effective
  261  date is shall be the date the agency receives the provider
  262  application. With respect to a provider that requires a Medicare
  263  certification survey, the enrollment effective date is the date
  264  the certification is awarded. With respect to a provider that
  265  completes a change of ownership, the effective date is the date
  266  the agency received the application, the date the change of
  267  ownership was complete, or the date the applicant became
  268  eligible to provide services under Medicaid, whichever date is
  269  later. With respect to a provider of emergency medical services
  270  transportation or emergency services and care, the effective
  271  date is the date the services were rendered. Payment for any
  272  claims for services provided to Medicaid recipients between the
  273  date of receipt of the application and the date of approval is
  274  contingent on applying any and all applicable audits and edits
  275  contained in the agency’s claims adjudication and payment
  276  processing systems. The agency may enroll a provider located
  277  outside this the state of Florida if:
  278         1. The provider’s location is no more than 50 miles from
  279  the Florida state line;
  280         2. The provider is a physician actively licensed in this
  281  state and interprets diagnostic testing results through
  282  telecommunications and information technology provided from a
  283  distance;, or
  284         3. The agency determines a need for that provider type to
  285  ensure adequate access to care; or
  286         (b) Deny the application if the agency finds that it is in
  287  the best interest of the Medicaid program to do so. The agency
  288  may consider the factors listed in subsection (10), as well as
  289  any other factor that could affect the effective and efficient
  290  administration of the program, including, but not limited to,
  291  the applicant’s demonstrated ability to provide services,
  292  conduct business, and operate a financially viable concern; the
  293  current availability of medical care, services, or supplies to
  294  recipients, taking into account geographic location and
  295  reasonable travel time; the number of providers of the same type
  296  already enrolled in the same geographic area; and the
  297  credentials, experience, success, and patient outcomes of the
  298  provider for the services that it is making application to
  299  provide in the Medicaid program. The agency shall deny the
  300  application if the agency finds that a provider; any officer,
  301  director, agent, managing employee, or affiliated person; or any
  302  partner or shareholder having an ownership interest equal to 5
  303  percent or greater in the provider if the provider is a
  304  corporation, partnership, or other business entity, has failed
  305  to pay all outstanding fines or overpayments assessed by final
  306  order of the agency or final order of the Centers for Medicare
  307  and Medicaid Services, not subject to further appeal, unless the
  308  provider agrees to a repayment plan that includes withholding
  309  Medicaid reimbursement until the amount due is paid in full.
  310         Section 2. Subsection (17) of section 409.910, Florida
  311  Statutes, is amended to read:
  312         409.910 Responsibility for payments on behalf of Medicaid
  313  eligible persons when other parties are liable.—
  314         (17) A recipient or his or her legal representative or any
  315  person representing, or acting as agent for, a recipient or the
  316  recipient’s legal representative, who has notice, excluding
  317  notice charged solely by reason of the recording of the lien
  318  pursuant to paragraph (6)(c), or who has actual knowledge of the
  319  agency’s rights to third-party benefits under this section, who
  320  receives any third-party benefit or proceeds therefrom for a
  321  covered illness or injury, must is required either to pay the
  322  agency, within 60 days after receipt of settlement proceeds, pay
  323  the agency the full amount of the third-party benefits, but not
  324  more than in excess of the total medical assistance provided by
  325  Medicaid, or to place the full amount of the third-party
  326  benefits in an interest-bearing a trust account for the benefit
  327  of the agency pending an judicial or administrative
  328  determination of the agency’s right to the benefits thereto.
  329  Proof that any such person had notice or knowledge that the
  330  recipient had received medical assistance from Medicaid, and
  331  that third-party benefits or proceeds therefrom were in any way
  332  related to a covered illness or injury for which Medicaid had
  333  provided medical assistance, and that any such person knowingly
  334  obtained possession or control of, or used, third-party benefits
  335  or proceeds and failed either to pay the agency the full amount
  336  required by this section or to hold the full amount of third
  337  party benefits or proceeds in an interest-bearing trust account
  338  pending an judicial or administrative determination, unless
  339  adequately explained, gives rise to an inference that such
  340  person knowingly failed to credit the state or its agent for
  341  payments received from social security, insurance, or other
  342  sources, pursuant to s. 414.39(4)(b), and acted with the intent
  343  set forth in s. 812.014(1).
  344         (a) A recipient may contest the amount designated as
  345  recovered medical expense damages payable to the agency pursuant
  346  to the formula specified in paragraph (11)(f) by filing a
  347  petition under chapter 120 within 21 days after the date of
  348  payment of funds to the agency or after the date of placing the
  349  full amount of the third-party benefits in the trust account for
  350  the benefit of the agency. The petition shall be filed with the
  351  Division of Administrative Hearings. For purposes of chapter
  352  120, the payment of funds to the agency or the placement of the
  353  full amount of the third-party benefits in the trust account for
  354  the benefit of the agency constitutes final agency action and
  355  notice thereof. Final order authority for the proceedings
  356  specified in this subsection rests with the Division of
  357  Administrative Hearings. This procedure is the exclusive method
  358  for challenging the amount of third-party benefits payable to
  359  the agency.
  360         1. In order to successfully challenge the amount payable to
  361  the agency, the recipient must prove, by clear and convincing
  362  evidence, that a lesser portion of the total recovery should be
  363  allocated as reimbursement for past and future medical expenses
  364  than the amount calculated by the agency pursuant to the formula
  365  set forth in paragraph (11)(f) or that Medicaid provided a
  366  lesser amount of medical assistance than that asserted by the
  367  agency.
  368         2. The agency’s provider processing system reports are
  369  admissible as prima facie evidence in substantiating the
  370  agency’s claim.
  371         3.Venue for all administrative proceedings pursuant to
  372  this subsection lies in Leon County, at the discretion of the
  373  agency. Venue for all appellate proceedings arising from the
  374  administrative proceeding outlined in this subsection lie at the
  375  First District Court of Appeal in Leon County, at the discretion
  376  of the agency.
  377         4. Each party shall bear its own attorney fees and costs
  378  for any administrative proceeding conducted pursuant to this
  379  paragraph.
  380         (b)(a) In cases of suspected criminal violations or
  381  fraudulent activity, the agency may take any civil action
  382  permitted at law or equity to recover the greatest possible
  383  amount, including, without limitation, treble damages under ss.
  384  772.11 and 812.035(7).
  385         1.(b) The agency may is authorized to investigate and to
  386  request appropriate officers or agencies of the state to
  387  investigate suspected criminal violations or fraudulent activity
  388  related to third-party benefits, including, without limitation,
  389  ss. 414.39 and 812.014. Such requests may be directed, without
  390  limitation, to the Medicaid Fraud Control Unit of the Office of
  391  the Attorney General, or to any state attorney. Pursuant to s.
  392  409.913, the Attorney General has primary responsibility to
  393  investigate and control Medicaid fraud.
  394         2.(c) In carrying out duties and responsibilities related
  395  to Medicaid fraud control, the agency may subpoena witnesses or
  396  materials within or outside the state and, through any duly
  397  designated employee, administer oaths and affirmations and
  398  collect evidence for possible use in either civil or criminal
  399  judicial proceedings.
  400         3.(d) All information obtained and documents prepared
  401  pursuant to an investigation of a Medicaid recipient, the
  402  recipient’s legal representative, or any other person relating
  403  to an allegation of recipient fraud or theft is confidential and
  404  exempt from s. 119.07(1):
  405         a.1. Until such time as the agency takes final agency
  406  action;
  407         b.2. Until such time as the Department of Legal Affairs
  408  refers the case for criminal prosecution;
  409         c.3. Until such time as an indictment or criminal
  410  information is filed by a state attorney in a criminal case; or
  411         d.4. At all times if otherwise protected by law.
  412         Section 3. Subsections (9), (13), (15), (16), (21), (22),
  413  (25), (28), (30), and (31) of section 409.913, Florida Statutes,
  414  are amended to read:
  415         409.913 Oversight of the integrity of the Medicaid
  416  program.—The agency shall operate a program to oversee the
  417  activities of Florida Medicaid recipients, and providers and
  418  their representatives, to ensure that fraudulent and abusive
  419  behavior and neglect of recipients occur to the minimum extent
  420  possible, and to recover overpayments and impose sanctions as
  421  appropriate. Beginning January 1, 2003, and each year
  422  thereafter, the agency and the Medicaid Fraud Control Unit of
  423  the Department of Legal Affairs shall submit a joint report to
  424  the Legislature documenting the effectiveness of the state’s
  425  efforts to control Medicaid fraud and abuse and to recover
  426  Medicaid overpayments during the previous fiscal year. The
  427  report must describe the number of cases opened and investigated
  428  each year; the sources of the cases opened; the disposition of
  429  the cases closed each year; the amount of overpayments alleged
  430  in preliminary and final audit letters; the number and amount of
  431  fines or penalties imposed; any reductions in overpayment
  432  amounts negotiated in settlement agreements or by other means;
  433  the amount of final agency determinations of overpayments; the
  434  amount deducted from federal claiming as a result of
  435  overpayments; the amount of overpayments recovered each year;
  436  the amount of cost of investigation recovered each year; the
  437  average length of time to collect from the time the case was
  438  opened until the overpayment is paid in full; the amount
  439  determined as uncollectible and the portion of the uncollectible
  440  amount subsequently reclaimed from the Federal Government; the
  441  number of providers, by type, that are terminated from
  442  participation in the Medicaid program as a result of fraud and
  443  abuse; and all costs associated with discovering and prosecuting
  444  cases of Medicaid overpayments and making recoveries in such
  445  cases. The report must also document actions taken to prevent
  446  overpayments and the number of providers prevented from
  447  enrolling in or reenrolling in the Medicaid program as a result
  448  of documented Medicaid fraud and abuse and must include policy
  449  recommendations necessary to prevent or recover overpayments and
  450  changes necessary to prevent and detect Medicaid fraud. All
  451  policy recommendations in the report must include a detailed
  452  fiscal analysis, including, but not limited to, implementation
  453  costs, estimated savings to the Medicaid program, and the return
  454  on investment. The agency must submit the policy recommendations
  455  and fiscal analyses in the report to the appropriate estimating
  456  conference, pursuant to s. 216.137, by February 15 of each year.
  457  The agency and the Medicaid Fraud Control Unit of the Department
  458  of Legal Affairs each must include detailed unit-specific
  459  performance standards, benchmarks, and metrics in the report,
  460  including projected cost savings to the state Medicaid program
  461  during the following fiscal year.
  462         (9) A Medicaid provider shall retain medical, professional,
  463  financial, and business records pertaining to services and goods
  464  furnished to a Medicaid recipient and billed to Medicaid for a
  465  period of 5 years after the date of furnishing such services or
  466  goods. The agency may investigate, review, or analyze such
  467  records, which must be made available during normal business
  468  hours. However, 24-hour notice must be provided if patient
  469  treatment would be disrupted. The provider must keep is
  470  responsible for furnishing to the agency, and keeping the agency
  471  informed of the location of, the provider’s Medicaid-related
  472  records. The authority of the agency to obtain Medicaid-related
  473  records from a provider is neither curtailed nor limited during
  474  a period of litigation between the agency and the provider.
  475         (13) The agency shall immediately terminate participation
  476  of a Medicaid provider in the Medicaid program and may seek
  477  civil remedies or impose other administrative sanctions against
  478  a Medicaid provider, if the provider or any principal, officer,
  479  director, agent, managing employee, or affiliated person of the
  480  provider, or any partner or shareholder having an ownership
  481  interest in the provider equal to 5 percent or greater, has been
  482  convicted of a criminal offense under federal law or the law of
  483  any state relating to the practice of the provider’s profession,
  484  or a criminal offense listed under s. 408.809(4), s.
  485  409.907(10), or s. 435.04(2) has been:
  486         (a) Convicted of a criminal offense related to the delivery
  487  of any health care goods or services, including the performance
  488  of management or administrative functions relating to the
  489  delivery of health care goods or services;
  490         (b) Convicted of a criminal offense under federal law or
  491  the law of any state relating to the practice of the provider’s
  492  profession; or
  493         (c) Found by a court of competent jurisdiction to have
  494  neglected or physically abused a patient in connection with the
  495  delivery of health care goods or services. If the agency
  496  determines that the a provider did not participate or acquiesce
  497  in the an offense specified in paragraph (a), paragraph (b), or
  498  paragraph (c), termination will not be imposed. If the agency
  499  effects a termination under this subsection, the agency shall
  500  take final agency action issue an immediate final order pursuant
  501  to s. 120.569(2)(n).
  502         (15) The agency shall seek a remedy provided by law,
  503  including, but not limited to, any remedy provided in
  504  subsections (13) and (16) and s. 812.035, if:
  505         (a) The provider’s license has not been renewed, or has
  506  been revoked, suspended, or terminated, for cause, by the
  507  licensing agency of any state;
  508         (b) The provider has failed to make available or has
  509  refused access to Medicaid-related records to an auditor,
  510  investigator, or other authorized employee or agent of the
  511  agency, the Attorney General, a state attorney, or the Federal
  512  Government;
  513         (c) The provider has not furnished or has failed to make
  514  available such Medicaid-related records as the agency has found
  515  necessary to determine whether Medicaid payments are or were due
  516  and the amounts thereof;
  517         (d) The provider has failed to maintain medical records
  518  made at the time of service, or prior to service if prior
  519  authorization is required, demonstrating the necessity and
  520  appropriateness of the goods or services rendered;
  521         (e) The provider is not in compliance with provisions of
  522  Medicaid provider publications that have been adopted by
  523  reference as rules in the Florida Administrative Code; with
  524  provisions of state or federal laws, rules, or regulations; with
  525  provisions of the provider agreement between the agency and the
  526  provider; or with certifications found on claim forms or on
  527  transmittal forms for electronically submitted claims that are
  528  submitted by the provider or authorized representative, as such
  529  provisions apply to the Medicaid program;
  530         (f) The provider or person who ordered, authorized, or
  531  prescribed the care, services, or supplies has furnished, or
  532  ordered or authorized the furnishing of, goods or services to a
  533  recipient which are inappropriate, unnecessary, excessive, or
  534  harmful to the recipient or are of inferior quality;
  535         (g) The provider has demonstrated a pattern of failure to
  536  provide goods or services that are medically necessary;
  537         (h) The provider or an authorized representative of the
  538  provider, or a person who ordered, authorized, or prescribed the
  539  goods or services, has submitted or caused to be submitted false
  540  or a pattern of erroneous Medicaid claims;
  541         (i) The provider or an authorized representative of the
  542  provider, or a person who has ordered, authorized, or prescribed
  543  the goods or services, has submitted or caused to be submitted a
  544  Medicaid provider enrollment application, a request for prior
  545  authorization for Medicaid services, a drug exception request,
  546  or a Medicaid cost report that contains materially false or
  547  incorrect information;
  548         (j) The provider or an authorized representative of the
  549  provider has collected from or billed a recipient or a
  550  recipient’s responsible party improperly for amounts that should
  551  not have been so collected or billed by reason of the provider’s
  552  billing the Medicaid program for the same service;
  553         (k) The provider or an authorized representative of the
  554  provider has included in a cost report costs that are not
  555  allowable under a Florida Title XIX reimbursement plan, after
  556  the provider or authorized representative had been advised in an
  557  audit exit conference or audit report that the costs were not
  558  allowable;
  559         (l) The provider is charged by information or indictment
  560  with fraudulent billing practices or an offense referenced in
  561  subsection (13). The sanction applied for this reason is limited
  562  to suspension of the provider’s participation in the Medicaid
  563  program for the duration of the indictment unless the provider
  564  is found guilty pursuant to the information or indictment;
  565         (m) The provider or a person who has ordered, authorized,
  566  or prescribed the goods or services is found liable for
  567  negligent practice resulting in death or injury to the
  568  provider’s patient;
  569         (n) The provider fails to demonstrate that it had available
  570  during a specific audit or review period sufficient quantities
  571  of goods, or sufficient time in the case of services, to support
  572  the provider’s billings to the Medicaid program;
  573         (o) The provider has failed to comply with the notice and
  574  reporting requirements of s. 409.907;
  575         (p) The agency has received reliable information of patient
  576  abuse or neglect or of any act prohibited by s. 409.920; or
  577         (q) The provider has failed to comply with an agreed-upon
  578  repayment schedule.
  579  
  580  A provider is subject to sanctions for violations of this
  581  subsection as the result of actions or inactions of the
  582  provider, or actions or inactions of any principal, officer,
  583  director, agent, managing employee, or affiliated person of the
  584  provider, or any partner or shareholder having an ownership
  585  interest in the provider equal to 5 percent or greater, in which
  586  the provider participated or acquiesced.
  587         (16) The agency shall impose any of the following sanctions
  588  or disincentives on a provider or a person for any of the acts
  589  described in subsection (15):
  590         (a) Suspension for a specific period of time of not more
  591  than 1 year. Suspension precludes shall preclude participation
  592  in the Medicaid program, which includes any action that results
  593  in a claim for payment to the Medicaid program for as a result
  594  of furnishing, supervising a person who is furnishing, or
  595  causing a person to furnish goods or services.
  596         (b) Termination for a specific period of time ranging of
  597  from more than 1 year to 20 years. Termination precludes shall
  598  preclude participation in the Medicaid program, which includes
  599  any action that results in a claim for payment to the Medicaid
  600  program for as a result of furnishing, supervising a person who
  601  is furnishing, or causing a person to furnish goods or services.
  602         (c) Imposition of a fine of up to $5,000 for each
  603  violation. Each day that an ongoing violation continues, such as
  604  refusing to furnish Medicaid-related records or refusing access
  605  to records, is considered, for the purposes of this section, to
  606  be a separate violation. Each instance of improper billing of a
  607  Medicaid recipient; each instance of including an unallowable
  608  cost on a hospital or nursing home Medicaid cost report after
  609  the provider or authorized representative has been advised in an
  610  audit exit conference or previous audit report of the cost
  611  unallowability; each instance of furnishing a Medicaid recipient
  612  goods or professional services that are inappropriate or of
  613  inferior quality as determined by competent peer judgment; each
  614  instance of knowingly submitting a materially false or erroneous
  615  Medicaid provider enrollment application, request for prior
  616  authorization for Medicaid services, drug exception request, or
  617  cost report; each instance of inappropriate prescribing of drugs
  618  for a Medicaid recipient as determined by competent peer
  619  judgment; and each false or erroneous Medicaid claim leading to
  620  an overpayment to a provider is considered, for the purposes of
  621  this section, to be a separate violation.
  622         (d) Immediate suspension, if the agency has received
  623  information of patient abuse or neglect or of any act prohibited
  624  by s. 409.920. Upon suspension, the agency must issue an
  625  immediate final order under s. 120.569(2)(n).
  626         (e) A fine, not to exceed $10,000, for a violation of
  627  paragraph (15)(i).
  628         (f) Imposition of liens against provider assets, including,
  629  but not limited to, financial assets and real property, not to
  630  exceed the amount of fines or recoveries sought, upon entry of
  631  an order determining that such moneys are due or recoverable.
  632         (g) Prepayment reviews of claims for a specified period of
  633  time.
  634         (h) Comprehensive followup reviews of providers every 6
  635  months to ensure that they are billing Medicaid correctly.
  636         (i) Corrective-action plans that would remain in effect for
  637  providers for up to 3 years and that are would be monitored by
  638  the agency every 6 months while in effect.
  639         (j) Other remedies as permitted by law to effect the
  640  recovery of a fine or overpayment.
  641  
  642  If a provider voluntarily relinquishes its Medicaid provider
  643  number or an associated license, or allows the associated
  644  licensure to expire after receiving written notice that the
  645  agency is conducting, or has conducted, an audit, survey,
  646  inspection, or investigation and that a sanction of suspension
  647  or termination will or would be imposed for noncompliance
  648  discovered as a result of the audit, survey, inspection, or
  649  investigation, the agency shall impose the sanction of
  650  termination for cause against the provider. The agency’s
  651  termination for cause action is subject to challenge under
  652  chapter 120. The Secretary of Health Care Administration may
  653  make a determination that imposition of a sanction or
  654  disincentive is not in the best interest of the Medicaid
  655  program, in which case a sanction or disincentive may shall not
  656  be imposed.
  657         (21) When making a determination that an overpayment has
  658  occurred, the agency shall prepare and issue an audit report to
  659  the provider showing the calculation of overpayments. The
  660  agency’s determination must be based solely upon information
  661  available to it before issuance of the audit report and, in the
  662  case of documentation obtained to substantiate claims for
  663  Medicaid reimbursement, based solely upon contemporaneous
  664  records. The agency may consider addenda or modifications to a
  665  note which were made contemporaneously with the patient care
  666  episode if the addenda or modification is germane to the note.
  667         (22) The audit report, supported by agency work papers,
  668  showing an overpayment to a provider constitutes evidence of the
  669  overpayment. A provider may not present or elicit testimony,
  670  either on direct examination or cross-examination in any court
  671  or administrative proceeding, regarding the purchase or
  672  acquisition by any means of drugs, goods, or supplies; sales or
  673  divestment by any means of drugs, goods, or supplies; or
  674  inventory of drugs, goods, or supplies, unless such acquisition,
  675  sales, divestment, or inventory is documented by written
  676  invoices, written inventory records, or other competent written
  677  documentary evidence maintained in the normal course of the
  678  provider’s business. A provider may not present records to
  679  contest an overpayment or sanction unless such records are
  680  contemporaneous and, if requested during the audit process, were
  681  furnished to the agency or its agent upon request. This
  682  limitation does not apply to Medicaid cost report audits and
  683  does not preclude consideration by the agency of addenda or
  684  modifications to a note if the addenda or modification is made
  685  before the notification of the audit and is germane to a note
  686  that was made contemporaneously with a patient care episode.
  687  Notwithstanding the applicable rules of discovery, all
  688  documentation to that will be offered as evidence at an
  689  administrative hearing on a Medicaid overpayment or an
  690  administrative sanction must be exchanged by all parties at
  691  least 14 days before the administrative hearing or must be
  692  excluded from consideration.
  693         (25)(a) The agency shall withhold Medicaid payments, in
  694  whole or in part, to a provider upon receipt of reliable
  695  evidence that the circumstances giving rise to the need for a
  696  withholding of payments involve fraud, willful
  697  misrepresentation, or abuse under the Medicaid program, or a
  698  crime committed while rendering goods or services to Medicaid
  699  recipients. If it is determined that fraud, willful
  700  misrepresentation, abuse, or a crime did not occur, the payments
  701  withheld must be paid to the provider within 14 days after such
  702  determination with interest at the rate of 10 percent a year.
  703  Amounts not paid within 14 days accrue interest at the rate of
  704  10 percent a year, beginning after the 14th day Any money
  705  withheld in accordance with this paragraph shall be placed in a
  706  suspended account, readily accessible to the agency, so that any
  707  payment ultimately due the provider shall be made within 14
  708  days.
  709         (b) The agency shall deny payment, or require repayment, if
  710  the goods or services were furnished, supervised, or caused to
  711  be furnished by a person who has been suspended or terminated
  712  from the Medicaid program or Medicare program by the Federal
  713  Government or any state.
  714         (c) Overpayments owed to the agency bear interest at the
  715  rate of 10 percent per year from the date of final determination
  716  of the overpayment by the agency, and payment arrangements must
  717  be made within 30 days after the date of the final order, which
  718  is not subject to further appeal at the conclusion of legal
  719  proceedings. A provider who does not enter into or adhere to an
  720  agreed-upon repayment schedule may be terminated by the agency
  721  for nonpayment or partial payment.
  722         (d) The agency, upon entry of a final agency order, a
  723  judgment or order of a court of competent jurisdiction, or a
  724  stipulation or settlement, may collect the moneys owed by all
  725  means allowable by law, including, but not limited to, notifying
  726  any fiscal intermediary of Medicare benefits that the state has
  727  a superior right of payment. Upon receipt of such written
  728  notification, the Medicare fiscal intermediary shall remit to
  729  the state the sum claimed.
  730         (e) The agency may institute amnesty programs to allow
  731  Medicaid providers the opportunity to voluntarily repay
  732  overpayments. The agency may adopt rules to administer such
  733  programs.
  734         (28) Venue for all Medicaid program integrity overpayment
  735  cases lies shall lie in Leon County, at the discretion of the
  736  agency.
  737         (30) The agency shall terminate a provider’s participation
  738  in the Medicaid program if the provider fails to reimburse an
  739  overpayment or pay an agency-imposed fine that has been
  740  determined by final order, not subject to further appeal, within
  741  30 35 days after the date of the final order, unless the
  742  provider and the agency have entered into a repayment agreement.
  743         (31) If a provider requests an administrative hearing
  744  pursuant to chapter 120, such hearing must be conducted within
  745  90 days following assignment of an administrative law judge,
  746  absent exceptionally good cause shown as determined by the
  747  administrative law judge or hearing officer. Upon issuance of a
  748  final order, the outstanding balance of the amount determined to
  749  constitute the overpayment and fines is shall become due. If a
  750  provider fails to make payments in full, fails to enter into a
  751  satisfactory repayment plan, or fails to comply with the terms
  752  of a repayment plan or settlement agreement, the agency shall
  753  withhold medical assistance reimbursement payments for Medicaid
  754  services until the amount due is paid in full.
  755         Section 4. Subsection (8) of section 409.920, Florida
  756  Statutes, is amended to read:
  757         409.920 Medicaid provider fraud.—
  758         (8) A person who provides the state, any state agency, any
  759  of the state’s political subdivisions, or any agency of the
  760  state’s political subdivisions with information about fraud or
  761  suspected fraudulent acts fraud by a Medicaid provider,
  762  including a managed care organization, is immune from civil
  763  liability for libel, slander, or any other relevant tort for
  764  providing the information about fraud or suspected fraudulent
  765  acts unless the person acted with knowledge that the information
  766  was false or with reckless disregard for the truth or falsity of
  767  the information. Such immunity extends to reports of fraudulent
  768  acts or suspected fraudulent acts conveyed to or from the agency
  769  in any manner, including any forum and with any audience as
  770  directed by the agency, and includes all discussions subsequent
  771  to the report and subsequent inquiries from the agency, unless
  772  the person acted with knowledge that the information was false
  773  or with reckless disregard for the truth or falsity of the
  774  information. As used in this subsection, the term “fraudulent
  775  acts” includes actual or suspected fraud and abuse, insurance
  776  fraud, licensure fraud, or public assistance fraud, including
  777  any fraud-related matters that a provider or health plan is
  778  required to report to the agency or a law enforcement agency.
  779         Section 5. Subsection (3) of section 624.351, Florida
  780  Statutes, is amended, and subsection (8) is added to that
  781  section, to read:
  782         624.351 Medicaid and Public Assistance Fraud Strike Force.—
  783         (3) MEMBERSHIP.—The strike force shall consist of the
  784  following 11 members or their designees. A designee shall serve
  785  in the same capacity as the designating member who may not
  786  designate anyone to serve in their place:
  787         (a) The Chief Financial Officer, who shall serve as chair.
  788         (b) The Attorney General, who shall serve as vice chair.
  789         (c) The executive director of the Department of Law
  790  Enforcement.
  791         (d) The Secretary of Health Care Administration.
  792         (e) The Secretary of Children and Family Services.
  793         (f) The State Surgeon General.
  794         (g) Five members appointed by the Chief Financial Officer,
  795  consisting of two sheriffs, two chiefs of police, and one state
  796  attorney. When making these appointments, the Chief Financial
  797  Officer shall consider representation by geography, population,
  798  ethnicity, and other relevant factors in order to ensure that
  799  the membership of the strike force is representative of the
  800  state as a whole.
  801         (8) EXPIRATION.—This section is repealed June 30, 2014.
  802         Section 6. Subsection (3) is added to section 624.352,
  803  Florida Statutes, to read:
  804         624.352 Interagency agreements to detect and deter Medicaid
  805  and public assistance fraud.—
  806         (3) This section is repealed June 30, 2014.
  807         Section 7. This act shall take effect July 1, 2013.

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