Florida Medicaid program paid $26M to private payers for dead beneficiaries
Luke Gale
Dec. 15, 2016
Dive Brief:

Private payers administering Medicaid in Florida received $26 million from July 2009 to November 2014 for beneficiaries whose deaths preceded payment dates, according to an HSS Office of the Inspector General (OIG) report.

The Florida Agency for Health Care Administration declared it had recovered nearly $24 million in overpayments identified by OIG and that $206,000 had not been paid in error.

The federal government pays for approximately 60% of Florida’s Medicaid program and its share of overpayments totaled $15.3 billion.
Dive Insight:

Overpayments were made largely due to incorrect information in state databases and lack of collaboration among state agencies, as well as with federal agencies. OIG recommended Florida implement policies to improve collaboration among state agencies and to routinely review state databases to ensure consistency with those maintained by federal agencies like the Department of Defense and the Social Security Administration.

So far, Florida is seeing mixed results since its decision to transition its Medicaid program to a managed care model. Florida had already moved Medicaid patients in two counties to MCO plans by July 2009 and completed a statewide transition by November 2014. The MCO model saved Florida money in its first year, but it is unclear if those savings can be sustained.

MCOs administering Medicaid in Florida have already called for rate increases, the Herald reported. Additionally, lawmakers discovered earlier this year that the state had underpaid MCOs by around $433 million in the first two years since the transition. The state Medicaid budget is also expected to grow by about $2 billion next year.

Florida won’t be alone if the shift to a managed care model costs more than anticipated. In Iowa, the private payers administering Medicaid have lost more than $100 million in a matter of months. Lawmakers in Iowa who had opposed the transition to a managed care model warn that these payers will likely call for higher rates, increasing the state’s costs in future years.

via OIG: Florida Medicaid program paid $26M to private payers for dead beneficiaries | Healthcare Dive

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