A year’s worth of audit reports newly compiled for lawmakers paints a troubling portrait of Florida’s Medicaid program but also sets a course for reform, a top state senator said Wednesday.
Health Regulation Committee Chairman Don Gaetz, R-Niceville, said the findings by the Florida Auditor General’s office “are not a pretty sight.” But they bolster legislative leaders’ attempts to steer more low-income Floridians into managed-care health coverage, he added.
“Managed care is not a magical elixir,” Gaetz conceded. “But managed care will work best when there are clear goals and sought-after results built into legislation.”
The Auditor General’s office has released what it describes as a “legislative briefing” that summarizes two years’ worth of audits of Medicaid, which is on track to exceed $20 billion next year, demanding an additional $1.4 billion in taxpayer dollars.
About 2.7 million Floridians are on Medicaid – with another 328,000 expected to join in coming months.
Among the more glaring findings in the audits: The state’s Agency for Health Care Administration paid $792 million in 6,692 emergency payments to hospitals, doctors and other health care providers “not clearly authorized by law or supported by valid claims.”
Auditors also faulted AHCA’s system for recovering overpayments. The state’s Department of Children & Families failed to fully document Medicaid eligibility for patients in 25 percent of the cases reviewed by auditors.
Nineteen nursing homes were paid $40.6 million during the 2008-09 year without the facilities submitting actual cost data, auditors found, leading AHCA to make payments based on its own estimates. “The agency is unable to ensure that nursing homes were paid the amounts legally authorized by law,” auditors said.
House and Senate leaders have already pledged to renew attempts to overhaul the program – building on proposals that failed to draw consensus last year. Legislative Democrats have warned the switch to managed care could disrupt health coverage for some of Florida’s sickest and frailest patients, rewarding private HMOs with new state contracts but saving the state little money.
Gaetz, though, said the push to managed care could be fortified if Republican Rick Scott is elected governor over Democrat Alex Sink.
Scott’s $218 million net worth stems largely from his leadership at hospital chain Columbia/HCA, which paid $1.7 billion to settle charges of Medicaid and Medicare fraud after he left the company.
“Scott is no stranger to the intricacies of health care financing,” Gaetz said.
By John Kennedy
The News Service of Florida
