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Three Counties Challenge State Medicaid Recoup

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Healthy Living

TALLAHASSEE (CBS4/NSF) – Three Florida counties are legally challenging the state’s attempt to recoup tens of millions of dollars in unpaid Medicaid claims.

The challenges by Broward, St. Lucie and St. Johns counties were sent Monday to the state Division of Administrative Hearings and mark the latest twist in a months-long legal and political fight about whether counties have paid their full shares of Medicaid costs during the past decade.

Lawmakers in March required the state Agency for Health Care Administration to gradually recover money that they said counties owed. Separate from the new DOAH cases, most counties also have signed onto a lawsuit challenging the constitutionality of the Legislature’s actions. The case is pending in Leon County circuit court.

Broward, St. Lucie and St. Johns filed the administrative cases after AHCA on Aug. 1 certified billings for a period from Nov. 1, 2001, through April 30, 2012. The billings stem from a longstanding requirement that counties reimburse the state for certain hospital and nursing-home costs for residents who are Medicaid beneficiaries.

Documents filed in the cases indicate Broward is challenging nearly $18.6 million in billings, while St. Lucie is challenging $11.9 million and St. Johns is challenging $763,268.

The counties base their challenges on several issues, including whether they could get charged for duplicate billings and whether addresses are adequate to prove where patients lived. They contend, in part, that some billings could be based on addresses such as post-office boxes, attorneys’ offices and commercial buildings — which raise questions about whether the patients actually lived in the counties.

Each county filed a petition with AHCA at the end of August seeking a formal administrative hearing to contest the billings. That led to AHCA sending the cases to the Division of Administrative Hearings, where they will be heard by an administrative law judge.

Initially, lawmakers argued that as much as $325 million in Medicaid money had gone unpaid in the past. But after the uproar, AHCA officials visited each county to work on billing issues and cut that estimate by about half.

(TM and © Copyright 2012 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2010 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The News Service of Florida contributed to this report.)

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