A Coral Gables-based HMO and a major Orlando hospital system are locked in a nasty contracting dispute that is about to land on the doorsteps of Central Florida residents.
Simply Healthcare Plans, Inc., said Friday it will start an advertising campaign charging that Orlando Health — the parent of Orlando Regional Medical Center and other hospitals — is being unfair to the minority-owned HMO and is denying Orange County residents the ability to get care through the plan.
Orlando Health rejected the allegations, saying Simply Healthcare’s minority ownership has “nothing to do with our ability to reach agreement with them” and that it has had difficulty in getting timely and accurate payment for services it has provided to Simply Healthcare patients.
The dispute comes as Florida prepares to move to a statewide managed-care system in the Medicaid program. HMOs, such as Simply Healthcare Plans, need to have contracts with hospitals if they hope to successfully compete for business in the overhauled Medicaid program.
A series of e-mails that Simply Healthcare Chairman Mike Fernandez sent to state officials last month indicates the HMO was having problems agreeing on contracts with Orlando Health and at least two other hospital systems. He also made clear that Simply Healthcare could start a public-relations campaign in the Orlando area.
“We have asked, begged, offered to pay above-market rates, as well as share profits, with these hospitals and all they do is slap us down,” Fernandez wrote in a May 24 e-mail to Liz Dudek, secretary of the state Agency for Health Care Administration. “This has been going on for two years!!!!!”
Simply Healthcare said in a news release Friday it will run a full-page advertisement in Monday’s Orlando Sentinel and described it as the “first in a series of public-awareness advertisements.”
The release also emphasized that Simply Healthcare is owned by Hispanics and African-Americans and said Orlando-area residents will be “denied the right to choose a minority-owned health plan that represents their particular needs.”
But Orlando Health said in a statement Friday night that it contracts with four of the eight Medicaid HMOs in its market, all of which have minorities as members.
“Simply’s proposed advertising campaign appears to be a coercive attempt by a company that owns a Medicaid HMO to force us to contract with them through the use of arguably deceptive practices,” Orlando Health said.
Contracting between HMOs and hospitals has been a long-simmering issue as the state transforms Medicaid into a managed-care system. HMOs will compete for Medicaid business in 11 regions and need to show the state they have adequate networks of providers, including hospitals.
Michael Garner, president of the Florida Association of Health Plans, an industry group, said he could not comment on Simply Healthcare or any other individual HMOs. But with the state choosing a limited number of HMOs in each region, he said health plans are preparing for a competitive process.
“I think many of them are looking at how best to organize right now and develop those types of networks,” Garner said.
AHCA plans to issue what is known as an “invitation to negotiate” July 1 for health plans interested in providing services to seniors who need long-term care and will follow Jan. 1 with an invitation to negotiate related to the broader Medicaid population. Marcio Cabrera, chief executive officer of Simply Healthcare, said the company will submit proposals for both portions of the program.
Simply Healthcare officials met Thursday with Dudek and AHCA staff about the Orlando Health dispute. AHCA spokeswoman Michelle Dahnke said in an e-mail Friday that the agency wanted to “see if there was an avenue, and if it was appropriate, for the Agency to help mitigate concerns.”
But AHCA does not have the power to require health plans and providers, such as hospitals, to enter into contracts.
“That said, we hope all Medicaid providers work collaboratively and keep the best interest of the recipient in mind,” Dahnke said in the e-mail.”In addition, the Agency hopes contracting practices between plans and providers are open, honest and fair.”
Simply Healthcare backed a proposal during this year’s legislative session that hospitals said would have effectively forced them to contract with managed-care plans. The proposal died amid heavy opposition from hospitals, which argue that such a requirement would reduce their negotiating leverage.
Cabrera described the legislative proposal as a “more global issue” than Simply Healthcare’s dispute with Orlando Health. The HMO also is in contract discussions with the Florida Hospital system, which, along with Orlando Health, is a major player in the Central Florida market.
Though not required statewide, hundreds of thousands of Medicaid beneficiaries are already enrolled in HMOs. Orlando Health said it treats Simply Healthcare patients who, for example, come to its emergency rooms.
It pinned at least part of the dispute on problems in getting payment for those services and also said Simply Healthcare has been “been unwilling to agree to the types of concessions that other Medicaid health plans have accepted” related to authorizing services, billing and claims payment.
.
Fernandez’s e-mails last month about the contracting problems went to top officials in AHCA, the governor’s office and the Legislature, including Senate Majority Leader Andy Gardiner, who is a vice president of Orlando Health.
In a May 23 e-mail to Dudek, Fernandez said Simply Healthcare had “tried every angle without success to reach a business compromise.”
“At this point, we have no choice but to go on a PR offensive as a minority owned (Hispanic and African American) health plan in good standing and extremely well-capitalized,” wrote Fernandez, who has been a major political contributor to the Republican Party of Florida and a political committee tied to Gov. Rick Scott.
By Jim saunders
