Category Archives: Florida Agency for Health Care Administration (AHCA)

Miami PIP Attorney Charged With Insurance Fraud

Miami attorney Anett Lopez was arrested on charges of taking part in a $1.5 million personal injury protection (PIP) fraud scheme.

Lopez is accused of filing lawsuits seeking reimbursements for the treatment of patients at Care Resources Group, a Miami healthcare clinic fraudulently operated under a straw owner.

A February investigation by the Florida Division of Investigative and Forensic Services (DIFS) uncovered that Care Resources Group was a PIP clinic illegally operating under a straw owner to avoid state licensing requirements. Lopez, straw owner Dr. Mario Torres and four others were arrested for alleged money laundering and soliciting of car accident victims in connection with the straw ownership of the clinic.

Lopez, who state authorities say was aware of the clinic’s straw ownership, filed lawsuits against at least a dozen insurance companies that resulted in payouts of nearly $1.5 million. Lopez faces seven counts each of insurance fraud and grand theft, and one count of organized scheme to fraud. She faces up to 85 years in prison if convicted of all 15 felonies.

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Filed under Fla. Stat. 627.736 (2012), Florida Agency for Health Care Administration (AHCA), Health care, Insurance Fraud, Miami-Dade County, Personal Injury Protection, PIP/No Fault

Florida Ahead Of Curve With Hospital Pricing Transparency Law

In the national push for pricing transparency in hospitals, Florida has moved to the front of the field.

Gov. Rick Scott signed a bill into law on April 14 that requires hospitals and other healthcare facilities in Florida to post the average amount they are paid for each procedure. That figure is far different from the standard charge information that must be posted in many states. Only New Hampshire, Colorado and Maine have laws similar to Florida’s new one. Law360 said the new law will let consumers shop around and allow Florida to limit Medicaid costs.

Scott made the transparency law a top priority for the 2016 Legislature, saying it will lower hospital costs. The Florida Agency for Health Care Administration (AHCA) is investigating whether managed care companies contracted through the state are overpaying for hospital services.

The law requires AHCA to use a consumer-friendly online platform where healthcare facilities post costs of procedures so consumers can compare them. Fines for failing to do so are increased under the law.

“The way patients are charged for services at the hospital should mirror a free market system,” Scott said in a statement. “We must ensure that prices and quality outcomes are aligned.”

“Florida emerges as a national leader in these efforts,” AHCA Secretary Elizabeth Dudek added in a statement.

Florida’s law is part of a nationwide movement to increase price transparency in healthcare, where negotiated rates are confidential and consumers often don’t know how much a procedure will cost.

The law goes into effect on July 1, but AHCA has until Oct. 1 to choose a vendor to create the online portal for pricing information.

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Filed under Florida Agency for Health Care Administration (AHCA), Health care