June 30, 2022

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Sunshine Health Plan settles $9M-plus fine with Florida for violating Medicaid contract

Florida’s biggest Medicaid managed care system compensated a $9 million great this week for failing to pay back, or to timely pay, 121,227 promises from overall health treatment vendors.

Agency for Health Treatment Administration (AHCA) Communications Director Brock Juarez told Florida Politics Sunshine Health Prepare paid the fine April 13, 5 times prior to it was thanks. In the meantime, the ban on automobile enrollment in the Medicaid managed treatment program stays in result, Juarez claimed.

Medicaid Assistant Deputy Secretary Brian Meyer on March 17 despatched a letter to Sunshine President and CEO Nathan Landsbaum advising him of the $9,092,025 penalty and other corrective steps the condition was taking towards the wellness program after failing to shell out the suppliers.

The point out levied a $75 fantastic for each and every delinquent payment. Meyer reported there were being 121,277 promises from well being treatment vendors in which payments have been possibly delayed or not designed at all. The claims ended up identified either as a result of complaints made to the condition from companies or by the well being strategy alone.

The $9 million wonderful is the largest the point out has levied in opposition to a Medicaid managed treatment system for agreement violations considering the fact that the inception of the Medicaid managed treatment software. Florida Politics 1st documented the historic fine on March 23.

Sunshine officers have earlier mentioned that the faults had been a final result of a software difficulty following the company’s merger final 12 months with WellCare which, at the time of the merger, had been the state’s 2nd biggest Medicaid managed care system guiding Sunshine. Former news accounts comprehensive how, for months, Sunshine failed to pay vendors for some of the state’s severely ill kids that acquire coverage as part of Medicaid’s children’s professional medical services portion. At least one particular supplier shut down.

As of March 31, there have been much more than 5.18 million persons enrolled in Florida’s Medicaid system, which is an all-time significant thanks to the COVID-19 pandemic and the Medicaid regulations involving the public health and fitness unexpected emergency.

Florida has a Medicaid managed care mandate for most persons who qualify, whether they are youthful or previous. As a consequence of the managed care mandate there are 4,075,825 beneficiaries who had been enrolled in a Medicaid managed treatment plan as of March 31. No health and fitness prepare has a lot more Medicaid enrollees than Sunshine Health, which dominates the market share with 38% of the enrollees. Sunshine’s footprint in the Medicaid managed care marketplace is larger than that of Humana Professional medical System and Simply Health care Plans, the 2nd and 3rd biggest ideas, respectively, merged.


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