8610028, 59G-9.070 - Florida Administrative Rules, Law, Code, Register

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Notice: 8610028

Notice of Proposed Rule

Department:

AGENCY FOR HEALTH CARE ADMINISTRATION

Division:

Medicaid

Chapter:

OVERSIGHT OF INTEGRITY

Overview

RULE:

59G-9.070

Administrative Sanctions on Providers, Entities, and Persons

PURPOSE:

The 2009 Legislature passed Senate Bill 1986 which revised laws within the jurisdiction of the Agency for Health Care Administration (“AHCA” or “Agency”). These statutory revisions will have an effect upon administrative sanctions and disincentives imposed upon a provider, entity, or person for each violation of any Medicaid – related law. In pertinent summary, Section 409.913, F.S., as revised during the 2009 Legislative session, requires the Agency to deny payment or require repayment for Medicaid services under certain circumstances; requires the Agency to immediately terminate a Medicaid provider’s participation in the Medicaid program as a result of certain adjudications against the provider or certain affiliated persons; requires the Agency to suspend or terminate a Medicaid provider’s participation in the Medicaid program if the provider or certain affiliated persons participating in the Medicaid program have been suspended or terminated by the Federal Government or another state; provides that a provider is subject to sanctions for violations of law as the result of actions or inactions of the provider or certain affiliated persons; requires that the Agency provide notice of certain administrative sanctions to other regulatory agencies within a specified period; requires the Agency to withhold or deny Medicaid payments under certain circumstances; requires the Agency to terminate a provider’s participation in the Medicaid program if the provider fails to repay certain overpayments from the Medicaid program; requires the Agency to post a list on its website of Medicaid providers and affiliated persons of providers who have been terminated or sanctioned; and requires the Agency to take certain actions to improve the prevention and detection of heath care fraud.

SUMMARY:

Rule modification is required to fully implement the revised and expanded statutory provisions, as summarized above. Additionally, to assist the Agency and the Legislature achieve their intended and mutual purpose of reducing and preventing fraud and abuse of the Medicaid program, it is necessary to modify the monetary sanctions, as a deterrent for violating laws governing the Medicaid program.

RULEMAKING AUTHORITY:

409.919 FS.

LAW:

409.907, 409.913, 409.9131, 409.920, 812.035 FS.

PRINT PUBLISH DATE:

5/7/2010 Vol. 36/18

COMMENTS:

From 5/7/2010 To 5/28/2010 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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