Tag Archives: AHCA

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

CFO Jeff Atwater Supports Fighting Fraud During 2015 Legislative Session

CFO Jeff Atwater supports the Health Care Clinic Proposed Legislation House Bill 1127 and Senate Bill 1306 that strengthen the Agency for Health Care Administration’s (“AHCA”) Health Care Clinic Act (“HCCA”). The proposed legislation:

  • Creates new certificate of exemption mandates for clinics exempted from mandatory licensure in HB 119 and criminal penalties for certain AHCA clinic violations;
  • Increases the number of crimes that may be investigated by the Division of Insurance Fraud;
  • Requires insurers to have SIU departments with specific requirements and establishes state oversight to help fight insurance fraud;
  • Creates additional criminal penalties for unlawful claims, whether paid or not.

Please click here to review the full summary.

For additional information you may visit www.flhouse.gov.

If you have any questions concerning this topic, please contact any member of the Roig Lawyers Insurance Services Group.

Contributing Authors:

MICHAEL A. ROSENBERG

MARK J. ROSE

MIGUEL R. ROURA

DENNIS LAROSA

 

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Filed under Fla. Stat. 627.736 (2008)

Owners of Sky Imaging, North Miami Beach Arrested Friday, More Than $1.5mil in Fraudulent PIP Claims

On Friday authorities arrested arrested Robbie N. Chamoun, 30, and Nazih Boulos Chamoun, 74, owners of Sky Imaging located in North Miami Beach for alleged PIP fraud.  The two are accused of operating an unlicensed accident clinic and fraudulently billing more than $1.5 million in auto-related claims to insurance companies.

Specifically the owners of Sky Imaging lacked licensing from the Agency of Healthcare Administration (AHCA) and instead enlisted a medical doctor to sign paperwork and pose as the clinic owner to qualify to bill Florida PIP insurers.

The article from the SunSentinel is available here.

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Filed under Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Insurance Fraud, Licensing

Florida Agency for Healthcare Administration (AHCA) Issues Memo on Potential Gap in PIP Licensing Requirement

On May 8, 2012, Florida’s Agency for Healthcare Administration (AHCA) issued a memorandum in an attempt to clarify the potential “gap” in the licensing requirements under Florida’s amended PIP law, Florida Statute 627.736.

The three page memorandum finds that entities that meet the exemption standards of Florida Statute 627.736(5)(h) do not need to obtain licenses to comply with the apparent licensing requirements under the July 1, 2012 amendment to the PIP statute.

Stuart Williams, General Counsel of AHCA, concludes in the memorandum:

Consonant with applicable rules of statutory construction, the Agency believes that the Act applies the same effective date of January 1, 2013 to both the new licensure requirement and the 5(h) exemption.

The full AHCA memorandum is available here.

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Filed under Fla. Stat. 627.736 (2012), Licensing

Agency for Health Care Administration Mobile App

Yesterday the Agency for Health Care Administration (AHCA) released its mobile app allowing consumers the ability to obtain medical provider location & driving directions. AHCA says the following about the app:

“I am excited the Agency is able to make this mobile technology available,” said Secretary Liz Dudek. “The mobile facility locator will provide residents, consumers and tourists with easy access to facility information and driving directions for Florida health care facilities.”

Consumers can search for a facility by license type, county, city, proximity distance or a combination of those options.  After a facility has been selected, the mobile app will provide directions using the same directions feature on FloridaHealthFinder.gov or enter the facility address into the phone’s independent navigation application.

The app also allows the consumer to learn what type of beds and capacity the facility offers, along with the names of the facility administrator and owner. From the app, the user can link directly to the facility’s specific website, if available, to learn more. This additional resource can assist consumers in finding health care facilities that are nearby to them and fit their needs.

To download the app on Itunes click here

To download the app on Android click here

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Filed under Fla. Stat. 627.736 (2008), Licensing