By Lynn Hatter
http://stream.publicbroadcasting.net/production/mp3/wfsu/local-wfsu-969193.mp3
Tallahassee, FL – In its decision to steer 2.8-million Floridians on Medicaid into private health insurance markets the legislature said the shift would cut down on fraud waste and abuse. But Lynn Hatter reports, during a meeting of the task force assigned to look at ways to cut down on fraud, there were some doubts on whether Medicaid managed care is the solution.
Florida Chief Financial Officer Jeff Atwater and State Attorney General Pam Bondi are leading the Medicaid Fraud Task Force. Monday they, along with the board's other members heard a presentation from the Agency for Healthcare Administration that seemed to endorse managed care as a solution to fraud. Roberta Bradford is AHCA's Deputy Medicaid Secretary.
"The plan has an incentive to really look at the providers and be vigilant about it and then the state looks at their process and can redirect the efforts as far as making sure the plans themselves are accountable and providing the state value."
Later on Bradford said the Agency was still looking into the benefits of managed care and its ability to combat fraud.
"We're assessing the legislation. I think we feel that the legislation is the right direction to move, that there are many benefits to managed care and I think like anything else, we might need to make sure there's appropriate accountability and monitoring."
Lawmakers passed two bills that move the state's Medicaid population from one where providers submit claims to the state and get reimbursed, to one where the state gives the money to insurance companies who then give it to the providers. During Monday's meeting of the fraud task force, Attorney General Pam Bondi had a question about that.
"Does the legislation say whether fraud against the HMO is fraud against the state, necessarily?"
Bradford: " I would have to double-check but not that I recall."
Department of Children and Families head David Wilkins, who also sits on the Medicaid fraud task force, wanted to know if the individual healthcare companies are required to monitor for fraud and wasteful spending.
"Will the individual HMO's have contractual obligations for a certain degree of fraud identification detection and reporting in addition to what you do at the state level?"
Bradford says the companies that will eventually come into the state to treat Medicaid patients are required to have internal controls and compliance officers on hand to look at claims. But opponents to the state's attempt at Medicaid managed care warn that those same companies will try to provide less care to Medicaid patients in order to boost profits.